Economics of Non-Communicable Diseases in India

Economics of Non-Communicable Diseases in IndiaNovember 2014A report by the World Economic Forum and the Harvard School of Public Health 2Economics of Non-Communicable Diseases in IndiaThe views expressed in this publication are those of the authors alone. They do not necessarily represent the decisions, policy or views of the World Economic Forum or the Harvard School of Public Health.World Economic Forum91-93 route de la CapiteCH-1223 Cologny/GenevaSwitzerlandTel.: +41 (0)22 869 1212Fax: +41 (0)22 786 2744Email: contact@weforum.orgwww.weforum.org© 2014 World Economic ForumAll rights reserved.This material may be copied, photocopied, duplicated, and shared provided that it is clearly attributed to the World Economic Forum. This material may not be used for commercial purposes.REF 131014Suggested citation: Bloom, D.E., Cafiero-Fonseca E.T., Candeias V, Adashi E., Bloom L., Gurfein L., Jané-Llopis E., Lubet, A., Mitgang E, Carroll O’Brien J, Saxena A (2014). Economics of Non-Communicable Diseases in India: The Costs and Returns on Investment of Interventions to Promote Healthy Living and Prevent, Treat, and Manage NCDs. World Economic Forum, Harvard School of Public Health, 2014.See http://www.weforum.org/issues/healthy-living 3Economics of Non-Communicable Diseases in IndiaContents4 Figures4 Ta b l e s4 Abbreviations and Acronyms5 Executive Summary6 The Voice of Leaders8 Background9 Impact of NCDs on Economic Growth9 The Indian Response10 NCDs – One Challenge among Many in India11 Aims of this Report12 Non-Communicable Diseases and Risk Factors in India13 The NCD Burden in India14 Prevalence of Risk Factors for NCDs15 Effects of Globalization and Urbanization on Risk Factors and NCDs16 NCDs in an Ageing India20 The Economic Burden of Non-Communicable Diseases in India21 The Macroeconomic Burden23 NCD Concerns in India’s Business Community26 Addressing Non-Communicable Diseases in India: Intervention Costs and Returns27 Methodology for Selecting Interventions28 Assessment Results: Category A Interventions37 Methods to Calculate ROI39 Results: Estimated Health Benefits Needed to Achieve a 15% ROI40 Principles for Measuring Return on Investment and Collecting Data41 Principles for Measuring the ROI of NCD Programmes41 ROI Data Collection Checklist42 Conclusions and Final Messages44 References50 Appendix A. Results from the Longitudinal Ageing Study in India54 Appendix B. Intervention Framework Summary Table55 Appendix C. Candidate Interventions56 Appendix D. Category B Interventions59 Appendix E. Return on Investment: Equations60 Appendix F. Sensitivity Analyses64 Report Preparation 4Economics of Non-Communicable Diseases in IndiaFiguresFigure 1. Urban Growth in India, 1950-2050Figure 2. Growth in Share of Elderly Population in India, 1950-2050Figure 3. Prevalence of Diabetes, Heart Disease, and Chronic Respiratory Disease, by Age (LASI Pilot, 2011)Figure 4. Measured Hypertension among the 45+ Population in India (LASI Pilot, 2010)Figure 5. Rates of Selected NCDs and Risk Factors for Men and Women (LASI Pilot, 2011)Figure 6. Reported Payment Mechanisms for Adults 45+ (%) (LASI Pilot, 2011)Figure 7. Contribution (%) of Each Disease to Lost Economic Output for India, 2012-2030Figure 8. Selection Process for InterventionsFigure 9. Map of Category A InterventionsTa ble sTa b l e 1. Prevalent NCDs in India, 2010Ta b l e 2. Prevalence of Selected NCDs and Risk Factors across Residence, Education and Income Groups (LASI Pilot: Karnataka, Kerala, Punjab and Rajasthan, 2011)Ta b l e 3. Economic Burden of NCDs in India, 2012–2030Ta b l e 4. Economic Burden of NCDs in India and China, 2012–2030Ta b l e 5. Perceptions of NCDs Seriously Impacting Business Ta b l e 6. Perceptions of NCDs at least Moderately Impacting BusinessTa b l e 7. NCD Prevention and Support: Prevalence of Company Policies and Programmes, Already EstablishedTa b l e 8. NCD Prevention and Support: Prevalence of Company Policies and Programmes, Already Established and Implemented Ta b l e 9. Health Benefit Needed to Achieve a 15% ROI over a 30-Year PeriodTa b l e A1. NCD Prevalence in Adults 45+, by Demographic Categories and Location (%)Ta b l e A 2. NCD Risk Factors in Adults 45+, by Demographic Categories and Location (%)Ta b l e A3. Healthcare Payment Mechanisms for Adults 45+, by Demographic Categories, Location and Disease Type (%)Ta b l e F1. Varying the Time HorizonTa b l e F2. Varying the Value of DALYs AvertedTa b l e F3. Varying the Desired ROITa b l e F4. Varying the Discount Rate Abbreviations and AcronymsANM ancillary nurse/midwifeBBH Bangalore Baptist HospitalBCVA best-corrected visual acuity BP blood pressureCI confidence intervalCKD chronic kidney diseaseCOPD chronic obstructive pulmonary diseaseCRD chronic renal diseaseCSC collaborative stepped careCVD cardiovascular disease DA LY disability-adjusted life yearEMERALD Emerging mental health systems in low- and middle-income countries