Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment

Sanjay Basu; John S Yudkin; Mohammed Jawad; Hala Ghattas; Bassam Abu Hamad; Zeina Jamaluddine; Gloria Safadi; Marie-Elizabeth Ragi; Raeda El Sayed Ahmad; Eszter P Vamos; Christopher Millett

doi:10.1371/journal.pgph.0003168

Reducing non-communicable diseases among Palestinian populations in Gaza: A participatory comparative and cost-effectiveness modeling assessment

PLOS Glob Public Health. 2024 May 2;4(5):e0003168. doi: 10.1371/journal.pgph.0003168. eCollection 2024.

Authors

Sanjay Basu^{1

2}, John S Yudkin³, Mohammed Jawad⁴, Hala Ghattas^{5

6}, Bassam Abu Hamad⁷, Zeina Jamaluddine⁸, Gloria Safadi⁵, Marie-Elizabeth Ragi⁵, Raeda El Sayed Ahmad⁵, Eszter P Vamos⁴, Christopher Millett^{4

9}

Affiliations

¹ Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, United States of America.
² Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
³ Division of Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom.
⁴ Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
⁵ Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon.
⁶ Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America.
⁷ School of Public Health, Al-Quds University, Jerusalem, Israel.
⁸ Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
⁹ National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal.

Abstract

We sought to assess the effectiveness and cost-effectiveness of potential new public health and healthcare NCD risk reduction efforts among Palestinians in Gaza. We created a microsimulation model using: (i) a cross-sectional household survey of NCD risk factors among 4,576 Palestinian adults aged ≥40 years old in Gaza; (ii) a modified Delphi process among local public health experts to identify potentially feasible new interventions; and (iii) reviews of intervention cost and effectiveness, modified to the Gazan and refugee contexts. The survey revealed 28.6% tobacco smoking, a 40.4% prevalence of hypertension diagnosis (with a 95.6% medication treatment rate), a 25.6% prevalence of diabetes diagnosis (with 95.3% on treatment), a 21.9% prevalence of dyslipidemia (with 79.6% on a statin), and a 9.8% prevalence of asthma or chronic obstructive pulmonary disease (without known treatment). A calibrated model estimated a loss of 9,516 DALYs per 10,000 population over the 10-year policy horizon. The interventions having an incremental cost-effectiveness ratio (ICER) less than three times the GDP per capita of Palestine per DALY averted (<$10,992 per DALY averted)(<$10,992 per DALY averted) included bans on tobacco smoking in indoor and public places [$34 per incremental DALY averted (95% CI: $17, $50)], treatment of asthma using low dose inhaled beclometasone and short-acting beta-agonists [$140 per DALY averted (95% CI: $77, $207)], treatment of breast cancer stages I and II [$730 per DALY averted (95% CI: $372, $1,100)], implementing a mass media campaign for healthier nutrition [$737 per DALY averted (95% CI: $403, $1,100)], treatment of colorectal cancer stages I and II [$7,657 per DALY averted (95% CI: $3,721, $11,639)], and (screening with mammography [$17,054 per DALY averted (95% CI: $8,693, $25,359)]). Despite high levels of NCD risk factors among Palestinians in Gaza, we estimated that several interventions would be expected to reduce the loss of DALYs within common cost-effectiveness thresholds.

Copyright: © 2024 Basu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This study was jointly funded by the UK’s Department for International Development (DFID), the Medical Research Council (MRC), the Economic and Social Research Council (ESRC) and Wellcome Trust’s Health Systems Research Initiative (HSRI) (MR/S012877/1). The funders played no role in the study design, results interpretation or the decision to submit for publication.