COUNTRY-LEVEL
DECISION MAKING

FOR CONTROL OF
CHRONIC DISEASES

Workshop Summary

Alexandra Beatty, Rapporteur

Board on Global Health

INSTITUTE OF MEDICINE
            OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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COUNTRY-LEVEL DECISION MAKING FOR CONTROL OF CHRONIC DISEASES Workshop Summary Alexandra Beatty, Rapporteur Board on Global Health

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This project was supported by funds from private donors. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the individuals or organizations that provided support for this project. International Standard Book Number-13: 978-0-309-25272-0 International Standard Book Number-10: 0-309-25272-5 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Country-Level Decision Making for Control of Chronic Diseases: Workshop Summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR A WORKSHOP ON DEFINING COUNTRY-LEVEL RESOURCE NEEDS FOR CARDIOVASCULAR DISEASE AND RELATED CHRONIC DISEASES1 RACHEL NUGENT (Chair), University of Washington KALIPSO CHALKIDOU, National Institute for Health and Clinical Excellence, United Kingdom VALENTÍN FUSTER, Mount Sinai Heart STEPHEN JAN, George Institute for Global Health PETER LAMPTEY, FHI360 DEREK YACH, PepsiCo Project Staff BRIDGET B. KELLY, Project Director/Senior Program Officer COLLIN WEINBERGER, Research Associate RACHEL PITTLUCK, Senior Program Assistant (through April 2011) LEIGH CARROLL, Senior Program Assistant (from April 2011) JULIE WILTSHIRE, Financial Associate PATRICK KELLEY, Director, Board on Global Health 1 Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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Reviewers T his report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confiden- tial to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Amanda Glassman, Center for Global Development Paul Holmes, USAID J. Jaime Miranda, Universidad Peruana Cayetano Heredia, Peru Rachel Nugent, University of Washington Theo Vos, University of Queensland, Australia Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by David R. Challoner, Emeritus, University of Florida. Appointed by the Institute of Medicine, he was responsible for making certain that an independent ex- amination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Re- sponsibility for the final content of this report rests entirely with the rap- porteur and the institution. vii

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Acknowledgments T he planning committee and project staff are deeply appreciative of the many valuable contributions from those who assisted us with this project. We offer our profound thanks to the presenters and discus- sants at the workshop, who gave so generously of their time and expertise. These individuals are listed in full in Appendix A. We are also grateful to the many participants who attended the workshop both in person and via the live webcast. The robust engagement of everyone in attendance was vital to the success of the event. During the planning of the workshop, we benefited enormously from in- put from Dan Chisholm, Tom Gaziano, Amanda Glassman, Louis Niessen, and Theo Vos, as well as from representatives of the UnitedHealth/National Heart, Lung, and Blood Institute Centers of Excellence, who provided valuable perspectives, feedback, and suggestions when they very graciously included us in their April 2011 meeting. A number of individuals contributed to the administrative and logistical success of this project. For their patience and assistance facilitating sched- uling and communication with the planning committee, we are grateful to Julia Addae-Mintah, Derek Cutler, Josie Kummer, and Jennifer Tsai. In addition, we extend many thanks to Anthony Mavrogiannis and the staff at Kentlands Travel for supporting the travel needs and requirements of this project. We thank Cornelia Lluberes for her help with logistics at the workshop during her summer internship. We also convey our gratitude for the hard work of the many other staff of the Institute of Medicine and the National Academies who supported the project at every stage. In particular, we greatly appreciate the work of Kathleen C. Ostapkovich, who assisted ix

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x ACKNOWLEDGMENTS with various aspects of the workshop during her time as a summer Research Associate. Finally, we are grateful for the tremendous generosity of the individual donors who made this workshop possible through their contributions to a fund that supports dissemination and follow-up activities for the 2010 Institute of Medicine report, Promoting Cardiovascular Health in the De- veloping World.

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Contents Acronyms xiii 1 Introduction 1 2 Progress, Needs, and Lessons Learned: Perspectives from Six Countries 7 3 Data Availability and Gaps in Four Countries 29 4 Examples of Tools for Costing, Economic Modeling, and Priority Setting 41 5 Approaches to Supporting Country-Led Action 63 6 Summary of Considerations for Developing a Toolkit for Country-Led Decision Making 69 References 83 APPENDIXES A Workshop Agenda 87 B Biographies 95 xi

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Acronyms BMI body mass index CDC U.S. Centers for Disease Control and Prevention DALY disability-adjusted life year EVIDEM Evidence and Value: Impact on Decision Making GDP gross domestic product HIV/AIDS human immunodeficiency virus/acquired immune deficiency syndrome INDEPTH International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries LiST Lives Saved Tool MCDA multi-criteria decision analysis NCD noncommunicable disease NGO nongovernmental organization NHLBI National Heart, Lung, and Blood Institute xiii

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xiv ACRONYMS UN United Nations UNFPA United Nations Population Fund USAID U.S. Agency for International Development WHO World Health Organization WHO-CHOICE CHOosing Interventions that are Cost Effective (WHO) WHO-STEPS STEPwise approach to Surveillance (WHO)