A Sierra Leone-specific adult health intervention package with an emphasis on noncommunicable diseases and risk factors

Abstract

Background: Sierra Leone has one of the highest mortality rates in the world, and non-communicable diseases (NCDs) comprise 40% of all deaths. This study seeks to identify the most cost-effective NCD interventions in Sierra Leone to guide use of limited public resources and inform the country’s pathway to Universal Health Coverage (UHC). Methods: This study builds on recommendations from Disease Control Priorities (DCP) 3rd edition, which presented “model” lists of interventions, including for NCDs, that could provide good value for money in low- and middle-income countries. These interventions were applied to the Sierra Leonean context using country-level epidemiological, demographic, and cost data. Incremental cost effectiveness ratios (dollars per disability-adjusted life-year averted) were calculated, then population size, structure, and mortality rates from various causes were projected from 2021-2030 under three different, sequentially expanding, sets of interventions based on the cost-effectiveness findings.Results: All intersectoral policies were deemed to be cost-effective and highest priority for implementation. At a cost-effectiveness threshold of 0.5x per GDP per capita, seven of 14 clinical interventions were cost-effective. At a threshold of 1-3x, an additional six clinical interventions were cost-effective. Scale-up of (i) the intersectoral policies only, (ii) the intersectoral policies plus the seven most cost-effective clinical interventions, and (iii) all intersectoral policies and the 13 cost-effective clinical interventions at a rate of an additional 2.5% of the population per year could prevent 3,500, 4,500, and 5,000 premature deaths in the year 2025 and prevention of a significant number of total premature deaths accrued between 2023-2030. As a share of the current government health budget, the costs of scaling up these three sets of interventions about one sixth, one fourth, and one third, respectively. Conclusion: We can conclude that (1) there are multiple options for taking action on NCDs that fit within the health budget, and (2) a number of interventions for NCDs appear to be as cost-effective as interventions that are currently being implemented. Thus, this list of interventions merit special consideration as part of a future health benefits package that will be developed for SLeSHI.