Bangladesh Priorities: Non-communicable Diseases, Koehlmoos et al.

Research written by four eminent American economists examines several strategies to combat non-communicable diseases in Bangladesh. They find that the most cost-effective solutions are those aimed at reducing hypertension and tobacco use.

 

Strategy	Takas of benefits per taka spent
Hypertension medication	18
Tobacco tax	8
Treat and immunize cervical cancer	0.4

Bangladesh already has an extensive network of 14,000 community clinics that span the country. This pre-existing infrastructure presents an opportunity to fight NCDs cost-effectively.

Hypertension, or abnormally high blood pressure, affects one in three women and one in five men over age 35. It’s also a primary risk factor for more serious conditions, including heart disease, stroke, and diabetes. But treatment is straightforward and fairly cheap: annual costs are about Tk 7,000 for each person, to cover screenings as well as medications like aspirin. 

Given the prevalence of high blood pressure, this solution could do a lot of good for a lot of people. Three quarters of all patients treated can expect to live three years longer on average. Overall, each taka spent toward these efforts over the next five years would give 37 takas of benefits.

Tobacco is also related to heart disease and is a big killer in Bangladesh: each year, 70,000 people die from tobacco-related causes. While men primarily smoke tobacco, and women generally use smokeless products, an estimated total of 41.3 million people over age 15 use tobacco of some sort—two out of every five people in that age group.

In many countries, taxing cigarettes has significantly reduced smoking. The researchers propose a tax on all tobacco products—and strict enforcement of the tax. Currently, tobacco is taxed at 35 percent of retail price, but the tax is often not enforced. A strictly enforced tax that rises to 50 percent of retail price by 2021 would lower tobacco consumption and avert more than 5,000 deaths each year. Each of these people would live at least 10 years longer than they would otherwise.

Increasing the tobacco tax to 50 percent over the next five years would do 8 takas of good for every taka spent.

A third chronic illness that the researchers examine is cervical cancer. It is one of the most deadly cancers for women in Bangladesh—it causes about 10,000 deaths each year. Although we know how to help, it turns out to be rather costly. The experts find that investment to vaccinate, screen, and treat cervical cancer would provide less than half a taka in benefits for each taka spent. As awful as this disease is, we have to consider whether there are other and better places a taka can be spent to help more women and men survive, for instance, in tackling high blood pressure.