QALYS, POOR KIDS IN POOR COUNTRIES, AND A MODICUM OF MORALITY

Scarcely a day or two goes by in the Desert of the Real when the Author does not throw out some bad news. Today will be no different. But first the good news.

According to UNICEF, global childhood mortality has been halved since 1960. In an article on the on-line edition of the International Herald Tribune it is reported:

Deaths among children under 5 have fallen by more than half since 1960, when they were estimated at more than 20 million, UNICEF said in a new report on the state of children worldwide. That figure dropped below 10 million for the first time in 2006, the latest year for which estimates are available.

"We've reduced the rate of child mortality by 60 percent," Ann Veneman, executive director of UNICEF, said in an interview in Geneva. "It's important that we show progress, that we can save lives."

But even after such dramatic gains in child survival, the new figures mean that 26,000 children still die every day from mostly preventable causes, UNICEF noted. Four million infants die in their first month of life and up to half of these in their first day.

WHY ARE LOTS OF KIDS STILL DYING?

Preventable diseases take nearly all of the kids. Measles, AIDs, and malaria kill many, along with malnutrition and pneumonia.

However, UNICEF noted that measles deaths in Africa have dropped by more than 90% in Africa due to a targeted program aimed specifically at measles.

Of course the basic reason that these kids are dying is extreme poverty and lack of access to basic healthcare services and drugs. But even the poorest countries sometimes have lower infant mortality rates than their wealthier neighbors.

WHERE ARE THE KIDS DYING?

Nearly half the deaths of children under 5 occurred in sub-Saharan Africa, where one child in six dies before that age, the report added. Almost three-quarters of the countries making little or inadequate progress are in Africa.

But India alone accounts for a quarter of the children dying in their first month of life, according to the International Times Herald article.

Progress has not been limited to countries enjoying economic success. China almost halved its rate of child mortality from 1960 to 2006, but some of the least developed countries, among them Eritrea, Laos and Mozambique, also managed to bring child mortality down by 40 percent or more, Veneman said.

Even in conflict-stricken Afghanistan, she said, citing data that was not available in time for the report issued Tuesday, preliminary indications suggest that child mortality has fallen by about 25 percent since 2003.

WHAT WOULD IT COST TO KEEP THE KIDS AROUND?

The short and simple answer is “not much”. Treated mosquito nets are available for a few dollars (Malaria prevention). Cheap and effective vaccinations are available for measles. Pneumonia is very treatable.

With regards to AIDS, western nations, including the US, are providing assistance to African Nations to reduce the devastation caused by this disease. President Bush has made AIDS a high priority issue in African foreign aid, and the Author had recently heard and read that Bush and this American commitment is having positive results. As an aside, the Bush “legacy” will probably be viewed negatively by most, including the Author. But if Bush’s efforts reduce the spread and suffering from AIDS in Africa, then he deserves credit for that effort.

COST-UTILITY RATIO, THE STORK, AND THE GRIM REAPER.

Finally, the numbers. Imagine, if you will, a water-cooler discussion between the Grim Reaper and that fabled deliverer of babies, the Stork.

The Stork: I just love babies. Just love them. I bring them in, but you, Grim Reaper, take them out. Why do you do that, Mr. Reaper. They are just starting their lives, bringing hope to their parents and their villages, their communities.

The Grim Reaper: Don’t blame me, Mr. Stork. I’m just doing my job. And I just moonlight as The Grim Reaper. I am a Healthcare Economist by day. I do The Grim Reaper thing because I have a lot of student loans to pay off.

It only takes a few dollars of preventative measures to save an African child from malaria, or a few dollars of vaccines to prevent nearly all preventable childhood deaths in poor regions of the world. We healthcare economists write papers every day about the cost-utility of preventative care. The medical community around the world knows that it costs very little to prevent these needless deaths and get these kids off to a healthy start. But some countries even lack these basic resources. And in areas devastated by civil war or social upheaval, it can be even worse. These countries may have the basic supplies and medicine to save the children. But battle lines and ethnic divisions may prevent healthcare and food from even reaching those in need.

The Stork: Thanks for informing me, Mr. Reaper. I will start donating part of my paycheck to charities and NGOs that aid such people in need.

QALYS, POOR KIDS, AND MEDIAN INCOME.

The Author has posted several times on QALYs (Quality-Adjusted Life Years). QALYs are a commonly used outcome measurement. And they can be linked to a cost-factor to make cost-utility measurements.

One QALY can be factored as one year of good health. For less than optimal health, quality-adjusted years can be used. For a rough example, consider that a treatment will yield two years of .5 quality of life, or five years of .2 quality of live. In all cases, each treatment will yield one QALY.

A. The intervention yields One year of good health, or one QALY.

B. The intervention yields Two years of .5 quality of life. (2 years * .5) equals one QALY.

C. The intervention yields Five years of .2 quality of life. (5 years * .2) equals one QALY.

Okay, but let’s plug in some numbers. From a societal perspective, considering that money spent on healthcare is a “scare resource”, what is a “fair” amount to provide a person additional QALY(s)? Is $100,000 too much? Is $10,000 too little?

The rough “value” of a gain in one QALY in the United States is $50,000. It is difficult to source this figure and the Author has never found the underlying calculation. In the United Kingdom (UK) the rough value of a QALY gain is £30,000.

Thus, in the US, one additional QALY is seen as cost effective if it costs $50,000 or less. And in the Great Britain, where the Pound is worth about two American Dollars, a QALY is cost effective if it costs less than $60,000. Using this measurement, about $10,000 more is spent in the UK for a QALY gain than in the US. It would appear that the UK is providing more healthcare per patient, not LESS, than the US.

But perhaps not. Let’s look further.

Interestingly, both the American QALY gain figure of $50,000 and UK QALY figure (£30,000) are about equal to the Median Household Incomes in each country. In 2006, the Median Household Income in the UK was £32,342. The 2006 Median Household Income for the US was $48, 201.

ONE QALY FOR ONE YEAR’S HOUSEHOLD WAGES?

Although the data is somewhat weak, there appears to be a rough correlation in the US and the UK to annual household income to a gain of one QALY.

Is this figure transferable to developing countries? Countries where UNICEF identifies high levels of childhood mortality? Should their lives be measured by comparable QALY values? Are QALYs only worth $500 in counties where the median household GDP is $500?

FOR THE PREVENTATIVE CARE WE ARE TALKING ABOUT, A COUPLE DAY’S WORTH OF WORK WILL SAVE A CHILD.

UNICEF can provide the measles vaccine for $.33 per dose. A UNICEF provided treated mosquito net is $1.44. We are not even talking about a fraction of median household income for a child in a developing country. We are talking about only a few days of median household income.

We are talking about pennies. Pennies for the lives of children. Just pennies. Pennies.

Your thoughts?

ONLY QUESTIONS TODAY IN THE DESERT OF THE REAL.