Table 1

Prioritising interventions in terms of impact on overall population health (net DALYs averted)

Intervention	(1)*	(2)†	(3)‡	(4)§	(5)¶	(6)**	(7)††	(8)‡‡
Intervention	ICER rank (most to least cost-effective)	ICER ($)	Population DALYs averted per 1000	Cases per annum (1000 s)	Total cost ($1000 s)	Cumulative cost ($1000 s)	Total DALYs averted	Net DALYs averted (1000s)
Male circumcision	38	22	45	4073	146 730	146 730	39 634	25 423
Management of obstructed labour	30	12	86	92	1100	147 829	2497	2026
Isoniazid preventive therapy for HIV+ no TB	4	1	887	55	80	147 909	1118	1098
First-line treatment for new TB cases for adults	5	3	393	14	178	148 087	1045	1002
First-line treatment for new TB cases for children	7	3	393	12	117	148 204	888	851
Management of pre-eclampsia (magnesium sulfate)	23	6	168	20	45	148 249	535	483
Clean practices and immediate essential newborn care (home)	9	3	368	671	416	148 665	237	227
Households owning at least one ITN/LLIN	33	13	77	6752	13 737	162 402	228	180
Caesarean section	43	32	31	34	672	163 073	327	157
Mass media	2	1	903	16 879	7609	170 682	150	148
Labour and delivery management	28	11	89	918	1281	171 964	170	139
PMTCT of HIV	27	11	94	53	600	172 564	157	130
First-line treatment for retreatment TB cases for adults	6	3	393	2	100	172 664	131	125
Caesarean section (with complication)	29	12	86	5	172	172 836	137	111
First-line treatment for retreatment TB cases for children	8	3	393	2	66	172 901	111	106
Malaria treatment: first trimester— uncomplicated	19	5	198	305	1025	173 927	109	100
Malaria treatment: Second trimester—uncomplicated	20	5	198	305	235	174 162	109	100
Voluntary counselling and testing	41	25	40	8031	36 309	210 471	167	98
Tetanus toxoid (pregnant women)	24	7	149	918	115	210 585	104	92
Measles vaccine	26	9	106	651	528	211 113	107	90
Rotavirus vaccine	22	6	177	651	3097	214 210	88	80
Antenatal care (four visits)	36	15	68	918	11 230	225 440	90	68
Malaria treatment: uncomplicated (adult, <36 kg)	11	4	260	4372	3463	228 903	59	56
Malaria treatment: uncomplicated (adult, >36 kg)	12	4	260	4372	4267	233 170	59	56
Malaria treatment: uncomplicated—second line (adult, >36 kg)	13	4	260	4372	1186	234 356	59	56
Malaria treatment: uncomplicated—second line (adult, <36 kg)	14	4	260	4372	593	234 949	59	56
Vaginal delivery, skilled attendance	31	12	83	918	5181	240 130	67	54
Isoniazid preventive therapy for children in contact with patients with TB	3	1	900	2	7	240 138	45	44
Interventions focused on men who have sex with men	48	51	20	34	1256	241 393	232	40
Pregnant women sleeping under an ITN	34	13	77	1469	2990	244 383	50	39
Newborn sepsis—full supportive care	39	24	42	81	417	244 800	60	37
Management of severe malnutrition (children)	46	50	20	51	2437	247 237	199	36
Vitamin A supplementation in pregnant women	25	7	140	124	125	247 362	33	30
Antenatal corticosteroids for preterm labour	40	25	40	165	406	247 768	47	28
Interventions focused on female sex workers	47	51	20	23	655	248 423	161	28
Cotrimoxazole for children	1	cost saving		127	220	248 643	0	23
Malaria treatment: uncomplicated (children, <15 kg)	15	4	260	1042	4576	253 219	14	13
Malaria treatment: uncomplicated (children, >15 kg)	16	4	260	1042	4768	257 987	14	13
Malaria treatment: uncomplicated—second line (children, <15 kg)	17	4	260	1042	35	2 58 023	14	13
Malaria treatment: uncomplicated—second line (children, >15 kg)	18	4	260	1042	71	258 093	14	13
Under five children who slept under ITN/LLIN	35	13	77	494	1006	259 099	17	13
Schistosomiasis mass drug administration	42	29	35	389	77	259 176	24	13
Antibiotics for pPRoM	45	40	25	64	39	259 214	30	10
Blood safety	37	15	66	40	1626	260 840	12	9
Vaginal delivery, with complication	32	12	83	138	804	261 644	10	8
Maternal sepsis case management	44	39	26	64	2731	264 375	20	7
Malaria treatment: pregnant Women —complicated	21	5	198	16	140	264 515	6	5
Case management of MDR TB cases	10	3	297	0	12	264 527	5	5
GIT tract cancer	63	804	1	0	3	264 530	0	0
Cervical cancer (first line)	65	1087	1	2	162	264 691	0	0
Ischaemic heart disease	61	453	2	128	4	264 695	0	0
IPT of malaria (pregnant women)	52	110	9	735	35	264 730	0	0
Diabetes, type I	57	296	3	23	4304	269 034	0	0
High cholesterol	49	68	15	223	6703	275 737	1	0
Basic psychosocial support, advice and follow-up, plus antiepileptic medication	50	82	12	506	1266	277 003	1	0
Treatment of depression	56	265	4	169	332	277 334	0	0
Diabetes, Type II	58	296	3	138	4211	281 545	0	-1
Treatment of acute psychotic disorders	66	1646	1	169	958	282 503	0	-1
Treatment of bipolar disorder	62	557	2	523	10 362	292 865	0	-1
Treatment of schizophrenia	67	1646	1	2363	13 413	306 278	0	−10
Hypertension	55	159	6	846	1338	307 616	44	−71
Zinc (diarrhoea treatment)	51	99	10	7455	1788	309 404	244	−150
ORS	54	153	7	8662	937	310 341	147	−221
Condoms	53	127	8	8031	22 883	333 223	482	−517
ART for men	59	312	3	332	21 159	354 382	1005	−4104
ART for women	60	312	3	509	32 440	386 823	1541	−6292
Paediatric ART	64	892	1	107	7657	394 480	1556	−21 074

*ICER rank: from most to least cost-effective.
†ICER ($): translated to 2016 US$ from original sources.
‡Population DALYs averted per 1000: 1/cost effectiveness ratio × 1000.
§Cases per annum (1000s): size of eligible patient populations for each intervention.
¶Total cost ($1000s): cost per patient × number of patients requiring the intervention.
**Cumulative costs ($1000 s): the total cost of the intervention and all previous interventions.
††Total DALYs averted: DALYs averted per patient × number of patients requiring the intervention.
‡‡Net DALYs averted (1000 s): Difference between the DALYs averted by an intervention and DALYs that could have been averted with any additional HCS resources required to implement it, calculated as DALYs averted per patient × number of patients requiring the intervention – cost per patient × number of patients requiring the intervention/(1/estimated marginal productivity of the HCS).
ART, antiretroviral therapy; DALY, disability adjusted life year; GIT, gastrointestinal; HCS, healthcare system; ICER, incremental cost effectiveness ratio; IPT, intermittent preventive therapy; ITN, insecticide-treated bed net; LLIN, long-lasting insecticidal net; MDR, multidrug resistant; ORS, oral rehydration salts; PMTCT, prevention of mother to child transmission; pPRoM, preterm premature rupture of membranes; TB, tuberculosis.