74 | Noncommunicable Diseases in Saudi Arabia
(2015 US dollars) for Costa Rica, US$18.45 billion for Jamaica, and US$477.33 billion for Peru. These two published studies are the only ones found using this model, which suggests that it may have a limited reach, perhaps because of the difficulty of accessing the model and underlying documentation. A more popular economic growth model is the UNICEF/UNDP OneHealth tool (WHO n.d.). This tool can be used to quantify the burden of disease resulting from the status quo, but it is most appropriate for evaluating interventions. The tool is intended primarily to inform strategic planning purposes, as it aims to answer the following questions: (1) What health system resources would be needed to implement strategic health plans, which may include a combination of policy initiatives, prevention, screening, and treatment programs? (2) How much would the strategic plan cost, by year, by input, and by health system level? (3) What is the estimated health impact of a group of NCD interventions (including pubic health, policy, and medical intervention)? (4) How do costs compare with estimated available financing? This model provides health care planners with a non-disease-specific framework for costing, impact analysis, budgeting, and financing for major diseases and health system components. Such a model can ultimately be used to estimate the direct and indirect costs of NCDs and to derive return on health system investments. This tool is used to analyze the return on investment of select NCD interventions in Saudi Arabia (UN Interagency Task Force on NCDs 2017). In addition to presenting return-on-investment estimates, use of the OneHealth tool, combined with locally available data, shows that the indirect costs of diabetes and cardiovascular dieases alone cost the Saudi economy US$13.0 billion annually or 2 percent of GDP. Presenteeism is responsible for 1.2 percent of the total, replacement costs account for 0.6 percent, and absenteeism accounts for 0.2 percent.
SUMMARY AND CONCLUSIONS This chapter presents three methods of quantifying the economic burden of NCDs: the cost-of-illness method, the VSL method, and the application of economic growth models such as WHO’s EPIC and UNICEF/UNDP’s OneHealth. Each takes a different perspective, includes different components of cost, focuses on different time frames, and uses different data and assumptions. Therefore, results are not directly comparable nor are they completely independent. However, each approach can provide a different picture of the economic burden that NCDs impose. This chapter shows that the direct costs of NCDs equal 11 percent of total annual health expenditures, and—when considering all aspects of productivity losses—may reduce GDP by nearly 7 percent. The disease-specific estimates suggest that the direct and indirect costs of diabetes are much greater than the burden of other NCDs considered in this chapter, accounting for slightly more than half of both the annual direct and indirect burden. These costs are estimated with great uncertainty due to incomplete data and many assumptions. Better estimates can be made available through greater access to the most recent 2019 World Health Survey and other local data sources, such as databases with information on health care use and claims. The VSL approach would benefit from Saudi Arabia–specific estimates of the value of a statistical life and from up-todate estimates of premature mortality resulting from NCDs.
