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Saving Millions for Just a Few Dollars

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By David Brown
Washington Post Staff Writer
Monday, April 3, 2006

Speed bumps.

Who would have thought those annoyances were one of the great health-care investments of our age?

At a cost of $5 for every year of life they save or year of disability they prevent, speed bumps are a bargain that no health minister in a poor country is going to want to pass up.

It's in the same league with these exceptionally good deals: once-a-year treatment to rid rural African children of intestinal worms -- $3 to save a year of disability -- and having extra measles vaccine on hand in clinics so kids who missed their shot can get one at the next visit -- $4.

Not much more expensive is making sure that people having heart attacks get a month's worth of aspirin and beta-blocker pills -- a $14 investment for every year of life saved. Or making sure that places such as Morocco and Oman offer a simple eyelid operation to people whose eyesight is threatened by a disease called trachoma -- $39 to save a year of sight.

Deep-brain stimulation for Parkinson's disease? At $31,114 for each year of life or disability saved, it's not a great choice for countries trying to stretch their health-care dollars.

The same is true for coronary bypass surgery. That operation is virtually routine in rich countries. But if poor and middle-income nations want to make it widely available, they can expect to spend $36,793 for every year of life saved.

This shopping list -- and much, much more -- is included in a 1,401-page book called "Disease Control Priorities in Developing Countries, Second Edition," being launched today in Beijing.

The volume is emblematic of global health strategies in the 21st century.

It is loaded with evidence; explicit about its methodology; attuned to cost-benefit trade-offs; produced by a collaboration of governments, foundations, international organizations and academics; written by 346 people from 34 countries; funded partly by Bill Gates; equipped with its own Web site ( http://www.dcp2.org/ ); and free to anyone with a computer.

It comes out of a massive effort called the Disease Control Priorities Project, whose purpose is to provide practical information about the world's many health problems and what works in the battles against them.

A companion volume, "Global Burden of Disease and Risk Factors," catalogues the amount of death and disability caused by 300 different health conditions -- including car accidents, alcoholism, cataracts, arthritis, syphilis and heart attacks. It updates, with statistics from 2001, a report first published 10 years ago.


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