scholarly journals Standardized Sensitivity Analysis in BCA: An Education Case Study

2019 ◽  
Vol 10 (S1) ◽  
pp. 206-223 ◽  
Author(s):  
Elina Pradhan ◽  
Dean T. Jamison
Keyword(s):  
Sensitivity Analysis ◽  
Mortality Risk ◽  
Mortality Rates ◽  
Complete Analysis ◽  
Middle Income ◽  
Mortality Risks ◽  
Middle Income Countries ◽  
Net Benefits ◽  
Wage Increases ◽  
Benefit Cost

Benefit-cost analyses of education policies in low- and middle-income countries have historically used the effect of education on future wages to estimate benefits. Strong evidence also points to female education reducing both the under-five mortality rates of their children and adult mortality rates. A more complete analysis would thus add the value of mortality risk reduction to wage increases. This paper estimates how net benefits and benefit-cost ratios respond to the values used to estimate education’s mortality-reducing impact including variation in these estimates. We utilize a ‘standardized sensitivity analysis’ to generate a range of valuations of education’s impact on mortality risks. We include alternative ways of adjusting these values for income and age differences. Our analysis is for one additional year of schooling in lower-middle-income countries, incremental to the current mean. Our analysis shows a range of benefit-cost ratios ranging from 3.2 to 6.7, and net benefits ranging from $2,800 to $7,300 per student. Benefits from mortality risk reductions account for 40% to 70% of the overall benefits depending on the scenario. Thus, accounting for changes in mortality risks in addition to wage increases noticeably enhances the value of already attractive education investments.

scholarly journals Estimating the Values of Mortality Risk Reductions in Low- and Middle-Income Countries

2017 ◽  
Vol 8 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Lisa A. Robinson
Keyword(s):  
Cost Analysis ◽  
Mortality Risk ◽  
Middle Income ◽  
Benefit Cost Analysis ◽  
Mortality Risks ◽  
Middle Income Countries ◽  
Statistical Life ◽  
Benefit Cost ◽  
Value Per Statistical Life ◽  
Low And Middle Income

The value of small changes in mortality risks, generally expressed as the value per statistical life, is an important parameter in benefit-cost analysis. However, little is known about the values held by populations in low- and middle-income countries. This article introduces a symposium that includes three additional articles which explore related theory and research.

scholarly journals Valuing Mortality Risk Reductions in Global Benefit-Cost Analysis

2019 ◽  
Vol 10 (S1) ◽  
pp. 15-50 ◽  
Author(s):  
Lisa A. Robinson ◽  
James K. Hammitt ◽  
Lucy O’Keeffe
Keyword(s):  
Mortality Risk ◽  
Income Elasticity ◽  
Lower Income ◽  
Middle Income ◽  
Income Differences ◽  
Benefit Cost Analysis ◽  
Middle Income Countries ◽  
Statistical Life ◽  
The Past ◽  
Benefit Cost

The estimates used to value mortality risk reductions are a major determinant of the benefits of many public health and environmental policies. These estimates (typically expressed as the value per statistical life, VSL) describe the willingness of those affected by a policy to exchange their own income for the risk reductions they experience. While these values are relatively well studied in high-income countries, less is known about the values held by lower-income populations. We identify 26 studies conducted in the 172 countries considered low- or middle-income in any of the past 20 years; several have significant limitations. Thus there are few or no direct estimates of VSL for most such countries. Instead, analysts typically extrapolate values from wealthier countries, adjusting only for income differences. This extrapolation requires selecting a base value and an income elasticity that summarizes the rate at which VSL changes with income. Because any such approach depends on assumptions of uncertain validity, we recommend that analysts conduct a standardized sensitivity analysis to assess the extent to which their conclusions change depending on these estimates. In the longer term, more research on the value of mortality risk reductions in low- and middle-income countries is essential.

scholarly journals Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

The Lancet ◽  
2013 ◽  
Vol 382 (9890) ◽  
pp. 417-425 ◽  
Author(s):  
Joanne Katz ◽  
Anne CC Lee ◽  
Naoko Kozuki ◽  
Joy E Lawn ◽  
Simon Cousens ◽  
...  
Keyword(s):  
Gestational Age ◽  
Mortality Risk ◽  
Low Income ◽  
Small For Gestational Age ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Analysis

scholarly journals The COVID-19 mortality effects of underlying health conditions in India: a modelling study

2020 ◽  
Author(s):  
Paul Novosad ◽  
Radhika Jain ◽  
Alison Campion ◽  
Sam Asher
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Age Distribution ◽  
Chronic Respiratory Disease ◽  
Health Conditions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Chronic Heart Disease

ABSTRACTObjectiveTo model how known COVID-19 comorbidities will affect mortality rates and the age distribution of mortality in a large lower middle income country (India), as compared with a high income country (England), and to identify which health conditions drive any differences.DesignModelling study.SettingEngland and India.Participants1,375,548 respondents aged 18 to 99 to the District Level Household Survey-4 and Annual Health Survey in India. Additional information on health condition prevalence on individuals aged 18 to 99 was obtained from the Health Survey for England and the Global Burden of Diseases, Risk Factors, and Injuries Studies (GBD).Main outcome measuresThe primary outcome was the proportional increase in age-specific mortality in each country due to the prevalence of each COVID-19 mortality risk factor (diabetes, hypertension, obesity, chronic heart disease, respiratory illness, kidney disease, liver disease, and cancer, among others). The combined change in overall mortality and the share of deaths under 60 from the combination of risk factors was estimated in each country.ResultsRelative to England, Indians have higher rates of diabetes (10.6% vs. 8.5%), chronic respiratory disease (4.8% vs. 2.5%), and kidney disease (9.7% vs. 5.6%), and lower rates of obesity (4.4% vs. 27.9%), chronic heart disease (4.4% vs. 5.9%), and cancer (0.3% vs. 2.8%). Population COVID-19 mortality in India relative to England is most increased by diabetes (+5.4%) and chronic respiratory disease (+2.3%), and most reduced by obesity (−9.7%), cancer (−3.2%), and chronic heart disease (−1.9%). Overall, comorbidities lower mortality in India relative to England by 9.7%. Accounting for demographics and population health explains a third of the difference in share of deaths under age 60 between the two countries.ConclusionsKnown COVID-19 health risk factors are not expected to have a large effect on aggregate mortality or its age distribution in India relative to England. The high share of COVID-19 deaths from people under 60 in low- and middle-income countries (LMICs) remains unexplained. Understanding mortality risk associated with health conditions prevalent in LMICs, such as malnutrition and HIV/AIDS, is essential for understanding differential mortality.SUMMARY BOXWhat is already known on this topicCOVID-19 infections in low- and middle-income countries (LMICs) are rising rapidly, with the burden of mortality concentrated at much younger ages than in rich countries.A range of pre-existing health conditions can increase the severity of COVID-19 infections.It is feared that poor population health may worsen the severity of the pandemic in LMICs.What this study addsThe COVID-19 comorbidities that have been studied to date may have only a very small effect on aggregate mortality in India relative to England and do not shift the mortality burden toward lower ages at all.India’s younger demographics can explain only a third of the substantial difference in the share of deaths under age 60 between India and England.However, mortality risk associated with health conditions prevalent in LMICs, such as malnutrition and HIV/AIDS, is unknown and research on this topic is urgently needed.

Abstract MP77: Will the World Health Organization’s “25 x 25” Goal Be Achieved? An Ecologic Time Trend Analysis of Relative and Absolute Premature Mortality Risk Due to Non-Communicable, Chronic Diseases

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Abigail Baldridge ◽  
Jay Pandit ◽  
Mark Huffman
Keyword(s):  
Chronic Diseases ◽  
Mortality Risk ◽  
Linear Models ◽  
Premature Mortality ◽  
World Health ◽  
Population Estimates ◽  
Middle Income ◽  
Middle Income Countries ◽  
Recent Trends ◽  
Log Linear

Objectives: To evaluate country-level time trends (1994-2011) in premature (30-69 years) mortality from non-communicable, chronic diseases (NCDs), including cardiovascular diseases, and to create forward projections to 2025 to evaluate the WHO’s goal of reducing the risk of premature mortality from NCDs by 25% by 2025. Methods: Using publicly available data from the WHO Mortality Database, we created annual estimates of risk of premature (30-69 years) NCD mortality (1994-2011). The sample included data from all countries reporting NCD mortality data from ≥2 years (n=116) and all countries reporting population estimates over the same years (n=135). We matched these datasets by country, year, division, administrative grouping and sex to reach a final sample of 60 countries (193 WHO Member States, 2011). We used ordinary least squares and log-linear Poisson regression models stratified by sex to evaluate the annual change in risk of premature mortality. We then created forward projections through 2025 using log-linear models. We used extrapolated premature mortality risk at 2025 and compared risk to 2010, with projected United Nations age- and sex-specific population estimates, to evaluate trends. Results: Among all included countries, the average (SD) risk of premature mortality from NCDs based on log-linear models in 1994 was 6.8 (4.2) and 3.9 (2.1) per 1,000 persons in men and women, respectively (Table 1). In 2010, men in lower-middle income countries had the highest rates of premature NCD mortality (7.2 [1.8] per 1,000), and women from high-income OECD countries had the lowest rates (2.0 [0.5] per 1,000). If recent trends continue, the median risk of premature mortality from NCDs will decrease by 25.1% (IQR 16.4, 37.0) by 2025. Conclusions: Among included countries, if recent trends in risk of premature death from NCDs continue to 2025, 50% of countries will achieve the WHO’s 25 x 25 goal. However, data are disproportionately missing from low- and middle-income countries, which appear less likely overall to achieve this goal.

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