Last week, the World Health Organization (WHO) published the second draft of the updated Appendix 3 of the Global action plan for the prevention and control of noncommunicable diseases (NCDs) 2013–2030 – also known as the NCD “best buys” and other recommended interventions. This revised draft includes more details and additional cost-effectiveness analyses.

WHO is currently accepting written comments on the second draft from civil society organisations via email at [email protected] by 28 August 2022. In addition, there will be an opportunity for a live informal consultation with non-States actors in official relations with WHO on 19 September 2022, for which a registration link will be made available on the consultation webpage early in September.

Sharing comments to strengthen the future generation of NCD cost-effective interventions

In NCD Alliance’s response to the first draft, we commended the strengths of the update, such as the inclusion of cost-effectiveness results for more interventions and based on the data from 62 low and middle-income countries, but we also shared some general reservations and recommendations on both the methodology and content of the first draft. These included the need for more information on the methodology and its limitations; the importance to retain the concept of NCD ‘best buys’; that recommended interventions should reflect the scope of their analyses; and that Appendix 3 needs to be consistent across sections and reflect the evolving NCD agenda.

The second draft of the updated Appendix 3 has addressed to a certain extent some of the concerns that NCD Alliance raised, and we will be preparing a second submission in consultation with our members during the following weeks. We also encourage the NCD community to submit individual responses with comments you may have based on the latest evidence and your own experience advocating and supporting the implementation of these cost-effective interventions.

Summarizing some of the main differences between the first and second drafts

• The second draft includes an overview that shows the proportion of interventions with a specific cost-effectiveness ratio per country income group, allowing Member States to see the proportion of interventions they could implement according to their cost thresholds.
• It recognizes that the absence of a cost-effectiveness analysis does not mean that the intervention is not cost-effective, affordable, or feasible; and that interventions that currently do not have a cost-effectiveness analysis will be considered for such an analysis in future updates with as data becomes available.
• It mentions that the evidence used for the modelling of interventions will be periodically revised and updated; and that a comparison across risk factors and diseases [sections] will be carried out to check consistency and differences.
• Under healthy diets, the second draft includes three cost-effectiveness analysis updates: the analysis for the intervention on mass media campaign for healthy diets has been expanded to add the effect size of campaigns on fruit and vegetable intake; a cost-effectiveness analysis has been performed to the intervention on unhealthy food marketing restrictions for children, showing the very good value-for-money of marketing restrictions; and the cost-effectiveness results on sugar-sweetened beverages taxation have been updated from the 2017 version, including now the intervention’s impact on oral health, in addition to weight and BMI.
• Under cardiovascular disease, WHO has added two additional recommended interventions without a cost-effectiveness analysis on (1) the treatment of hypertension using single pill combination anti-hypertensives; and (2) secondary prevention of coronary heart disease with a statin, ACE-I, beta-blocker, and acetylsalicylic acid (low dose).