Table 1

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

Intervention(1)*(2)†(3)‡(4)§(5)¶(6)**(7)††(8)‡‡
ICER rank (most to least cost-effective)ICER ($)Population DALYs averted per 1000Cases per annum (1000 s)Total cost ($1000 s)Cumulative cost ($1000 s)Total DALYs avertedNet DALYs averted (1000s)
Male circumcision3822454073146 730146 73039 63425 423
Management of obstructed labour301286921100147 82924972026
Isoniazid preventive therapy for HIV+ no TB418875580147 90911181098
First-line treatment for new TB cases for adults5339314178148 08710451002
First-line treatment for new TB cases for children7339312117148 204888851
Management of pre-eclampsia (magnesium sulfate)2361682045148 249535483
Clean practices and immediate essential newborn care (home)93368671416148 665237227
Households owning at least one ITN/LLIN331377675213 737162 402228180
Caesarean section43323134672163 073327157
Mass media2190316 8797609170 682150148
Labour and delivery management2811899181281171 964170139
PMTCT of HIV27119453600172 564157130
First-line treatment for retreatment TB cases for adults633932100172 664131125
Caesarean section (with complication)2912865172172 836137111
First-line treatment for retreatment TB cases for children83393266172 901111106
Malaria treatment: first trimester— uncomplicated1951983051025173 927109100
Malaria treatment: Second trimester—uncomplicated205198305235174 162109100
Voluntary counselling and testing412540803136 309210 47116798
Tetanus toxoid (pregnant women)247149918115210 58510492
Measles vaccine269106651528211 11310790
Rotavirus vaccine2261776513097214 2108880
Antenatal care (four visits)36156891811 230225 4409068
Malaria treatment: uncomplicated (adult, <36 kg)11426043723463228 9035956
Malaria treatment: uncomplicated (adult, >36 kg)12426043724267233 1705956
Malaria treatment: uncomplicated—second line (adult, >36 kg)13426043721186234 3565956
Malaria treatment: uncomplicated—second line (adult, <36 kg)1442604372593234 9495956
Vaginal delivery, skilled attendance3112839185181240 1306754
Isoniazid preventive therapy for children in contact with patients with TB3190027240 1384544
Interventions focused on men who have sex with men485120341256241 39323240
Pregnant women sleeping under an ITN34137714692990244 3835039
Newborn sepsis—full supportive care39244281417244 8006037
Management of severe malnutrition (children)465020512437247 23719936
Vitamin A supplementation in pregnant women257140124125247 3623330
Antenatal corticosteroids for preterm labour402540165406247 7684728
Interventions focused on female sex workers47512023655248 42316128
Cotrimoxazole for children1cost saving127220248 643023
Malaria treatment: uncomplicated (children, <15 kg)15426010424576253 2191413
Malaria treatment: uncomplicated (children, >15 kg)16426010424768257 9871413
Malaria treatment: uncomplicated—second line (children, <15 kg)1742601042352 58 0231413
Malaria treatment: uncomplicated—second line (children, >15 kg)184260104271258 0931413
Under five children who slept under ITN/LLIN3513774941006259 0991713
Schistosomiasis mass drug administration42293538977259 1762413
Antibiotics for pPRoM4540256439259 2143010
Blood safety371566401626260 840129
Vaginal delivery, with complication321283138804261 644108
Maternal sepsis case management443926642731264 375207
Malaria treatment: pregnant Women —complicated21519816140264 51565
Case management of MDR TB cases103297012264 52755
GIT tract cancer63804103264 53000
Cervical cancer (first line)65108712162264 69100
Ischaemic heart disease6145321284264 69500
IPT of malaria (pregnant women)52110973535264 73000
Diabetes, type I572963234304269 03400
High cholesterol4968152236703275 73710
Basic psychosocial support, advice and follow-up, plus antiepileptic medication5082125061266277 00310
Treatment of depression562654169332277 33400
Diabetes, Type II5829631384211281 5450-1
Treatment of acute psychotic disorders6616461169958282 5030-1
Treatment of bipolar disorder62557252310 362292 8650-1
Treatment of schizophrenia6716461236313 413306 2780−10
Hypertension5515968461338307 61644−71
Zinc (diarrhoea treatment)51991074551788309 404244−150
ORS5415378662937310 341147−221
Condoms531278803122 883333 223482−517
ART for men59312333221 159354 3821005−4104
ART for women60312350932 440386 8231541−6292
Paediatric ART6489211077657394 4801556−21 074
  • *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.