In 2023, the world will be at “halftime” with respect to the sustainable development goals (SDGs). This midline acts as an important milestone to review the progress of the SDGs and develop policies based on the most effective interventions. To estimate the remaining resources needed to achieve SDG targets for vaccines from 2023 to 2030 as well the resulting economic benefits, in this analysis, the incremental economic benefit-cost ratio (BCR) for immunization programs in 80 low- and middle-income countries targeted by the Global Vaccine Action Plan from 2023 to 2030 is calculated. Of these 80 countries, 27 are classified as low-income countries and 53 are classified as lower-middle-income countries (LMICs). The economic evaluation covers 9 vaccines employed against 10 antigens and delivered through both routine immunization programs and supplemental immunization activities. The vaccines covered in the analysis include pentavalent vaccine, human papillomavirus vaccine, Japanese encephalitis vaccine, measles vaccine, measles-rubella vaccine, meningococcal conjugate A vaccine, pneumococcal conjugate vaccine, rotavirus vaccine, and yellow fever vaccine, and correspond to the vaccines covered in the return-on-investment estimates presented in Sim et al., which covered 94 LMICs from 2011 to 2030. For these countries, we estimate program costs from the health system perspective, including vaccine costs such as costs to procure vaccines, which incorporate injection supplies and freight; and immunization delivery costs, which include nonvaccine commodity costs to deliver immunizations to target populations and incorporate labor, cold chain and storage, transportation, facilities, training, surveillance, and wastage. Economic benefits are calculated using a value of statistical life year (VSLY) approach applied to modeled cases, and deaths averted are converted into averted years of life lost using life expectancy data. BCRs are presented as the final output that compares incremental costs and benefits from the baseline of 2022 levels, assuming diminishing returns to scale. Overall, for this period, we estimate total costs of US$ 7,581,837,329.08 with VSLY benefits of US$ 762,172,371,553.54, resulting in a BCR of 100.53.

Regulatory impact analyses of proposed environmental, occupational, and consumer product safety regulations often rely on a metric known as the Value per Statistical Case of Cancer (VSCC), that is, the public’s willingness to pay (WTP) for reductions in the risk of developing cancer. In this paper, we ask whether the VSCC depends on cancer survival prospects. We develop a simple theoretical model that shows that under standard assumptions the VSCC is decreasing in the chance of surviving cancer. We empirically test this prediction by means of a stated preference survey, where we ask subjects aged 45–60 from the general population in the Czech Republic to report information about their WTP for reductions in the risk of getting cancer. One half of the sample was told that, if they got cancer, the 5-year survival rate was 60 % (corresponding to the average survival chances across all types of cancer), while the other half was told that it was 75 %. Consistent with the theoretical model, we find that the VSCC is larger in the former group. The ratio between the VSCC of the two groups is approximately equal to the ratio between the conditional cancer mortality risks implied by the survey’s survival rates, suggesting that the VSCC is proportional to conditional cancer mortality. Our findings have important policy implications in the context of regulations that focus on pollutants linked to cancers with different chances of survival.

This paper conducts a benefit–cost analysis of expanding agricultural research and development (R&D) in the Global South. We extend a recent modeling exercise that used IFPRI’s IMPACT model to estimate the investments required to reduce the global prevalence of hunger below 5%. After 35 years, the increased funding is estimated to increase agricultural output by 10%, reduce the prevalence of hunger by 35%, reduce food prices by 16%, and increase per capita incomes by 4% relative to a counterfactual where funding continues to rise on historical trends. Using an 8% discount rate, the net present value of the costs of agricultural R&D are estimated at $61 billion for the next 35 years, while the net present benefits in terms of net economic surplus (the sum of consumer and producer surplus) are estimated at $2.1 trillion. The central estimate of the benefit–cost ratio (BCR) is 33, consistent with previous research documenting high average returns to agricultural research and development. The central BCR reported in this study places the intervention at the 91st percentile of all previous Copenhagen Consensus BCRs in agriculture, and 87th percentile for all BCRs regardless of sector. Agricultural R&D is likely one of the best uses of resources for the remainder of the Sustainable Development Goals and decades beyond.

We review the practice of safety benefits analysis for federal transportation regulations in the USA. Using a case-study approach, we explore the linkages between risk assessment and benefits analysis, adding to previous work exploring these linkages for environmental health regulations. Challenges for calculating the benefits of transportation safety regulations arise because safety outcomes, like many noncancer health effects, typically do not have formal risk relationships like dose–response functions established for them. Analysts often rely on engineering or other expert judgments or resort to qualitative discussions to connect a regulatory intervention to its intended outcome. Challenges also arise when regulatory outcomes are intangible or do not have established metrics. Safety outcomes are not always measurable in concrete terms like mortality risk and may include difficult-to-operationalize concepts like “safety culture.” If the outcome is not measurable, then quantifying or monetizing the expected effects of a regulation is not possible, and the ability to conduct robust qualitative discussions also may be limited. Economists evaluating benefits for safety regulations encounter limitations analogous to difficulties found in health regulations. To inform policymaking effectively, economists and safety experts could look to the relationship developed in environmental economics between economists and health scientists.

We make four main contributions in this paper related to the theory and practice of benefit–cost analysis (BCA). First, we show that most BCAs of policy interventions do not consider the welfare consequences in secondary markets, where goods or services can be complements or substitutes to those in the directly regulated markets. Second, we provide a general theoretical analysis for examining the sign of welfare effects in secondary markets, showing how the results depend on the welfare measure of interest and on whether the goods are complements or substitutes. We conclude that the welfare effects in secondary markets will typically be negative in cases most relevant for policy analysis. Third, we develop a straightforward tool that BCA analysts can use to evaluate the potential magnitude of secondary-market effects in particular applications. The tool itself highlights how secondary markets are likely to be relatively small in most circumstances. Finally, we illustrate use of the tool in different applications that provide further evidence that secondary-market effects are likely to be small.

This paper presents new benefit–cost estimates for the Tulsa universal pre-K program. These calculations are based on estimated effects, from two recent papers, of Tulsa pre-K on high-school graduation rates and college attendance rates of students who were in kindergarten in the fall of 2006. In the current paper, educational effects from these prior papers are used to infer lifetime earnings effects. Our conservative estimates suggest that per pre-K participant, the present value of earnings effects in 2021 dollars is $25,533, compared with program costs of $9,628, for a benefit–cost ratio of 2.65. Compared to prior benefit–cost studies of Tulsa pre-K, this benefit–cost ratio is below what was predicted from Tulsa pre-K’s effects on kindergarten test scores, but above what was predicted from Tulsa pre-K’s effects on grade retention by ninth grade. This fading and recovery of predicted pre-K effects as children go through K-12 and then enter adulthood is consistent with prior research. It suggests that pre-K may have important effects on “soft skills,” such as persisting in school, and reminds us that short-term studies of pre-K provide useful information for public policy.

The goal of natural resource damage assessment (NRDA) is to compensate the public for losses to natural resources from past or ongoing hazardous releases, including losses that may persist into the future. Compensation is delivered in the form of restoration projects. Resolving NRDA liability requires balancing losses and restoration benefits over multiple decades and converting them into a present value for calculating appropriate damages. For the past two decades, NRDA practitioners have used a real discount rate of 3 % to convert losses and benefits to a present value equivalent. That rate was based, in part, on real historical yields on risk-free debt (e.g., the real rate of return on 3-month Treasury bills). Declining interest rates on risk-free debt in recent years has led to suggestions to reexamine the historical consensus discount rate. This paper reviews two alternative conceptual paradigms for selecting a discount rate in NRDA cases: the social rate of time preference and discount rates for tort cases. We summarize historical data for empirically implementing the two paradigms and discuss the ramifications of the different options. Based on our review, we suggest maintaining the 3 % consensus as a practical solution to a range of empirical candidates within the two conceptual paradigms.

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.

Intentional violence against healthcare workers inflicts a physical and mental toll, motivating legislative proposals to better regulate these occupational risks. This article uses this context to address two novel issues for benefit assessment raised by injuries from assailants: potential heterogeneity in valuation based on the context of the injury risk and possible reductions in self-reported valuations when the exposed population has been trained to feel responsible for the risk. This article presents experimental evidence on workers’ preferences over the form of intervention: protection (risk reduction) or insurance (cost-sharing). The experiment also elicits worker valuations of occupational health care risks, calculating the value of a statistical injury (VSI), based on local wage-risk tradeoffs, in the general range of $200,000. Workers accord a premium to risk reductions that might eliminate the risk of injuries. Both the physical harm and the process by which the injury occurs may affect benefit assessments for the regulation of workplace violence. Non-healthcare participants require a $40,000 premium per expected injury resulting from intentional harm. While health care workers do not generally require such a premium, health care workers in clinical positions require more compensation to face occupational risks. Insurance coverage for monetary losses is more highly valued than protective measures for accidental harms, though there is no significant comparable preference for insurance against intentional harms. The results have important practical implications for addressing the concerning phenomenon of violence against healthcare workers, suggesting that expanding insurance compensation would be desirable, as would assigning an intentionality premium to intentional injuries.

Undernutrition and micronutrient deficiencies are key drivers of infant and child mortality and are causes of impaired human potential for hundreds of millions of children every year. Investing in nutrition in the first 1,000 days from conception not only supports individual lifetime health, education, and productivity, but is also key to breaking the intergenerational cycle of malnutrition and enhance equitable development pathways for low- and middle-income countries. This paper provides a cost–benefit analysis of three nutrition interventions: 1) provision of preventive small-quantity lipid-based nutrient supplements (SQ-LNS) to children 6−23 months of age; 2) Complementary Feeding Promotion (CFP) for children 6−23 months of age; 3) provision of multiple micronutrient (MMN) and calcium (Ca) supplements to pregnant women. The benefit–cost ratios (BCRs) for MMN supplementation for pregnant women replacing iron and folic acid (37.5), as well as MMN and Ca combined (19-24), are the highest. The BCRs for CFP for children in the two highest socio-economic status (SES) quintiles and SQ-LNS for children in the three lowest SES quintiles are fairly similar at 16 and 14, respectively. The lowest BCR is for CFP for children in the three lowest SES quintiles due to the high cost of accomplishing behavioral change for improved complementary feeding in resource-poor households.

Border management is a government activity affecting immigration and the economy. Benefit–cost and equivalent decision analyses are used to evaluate U.S. border management for 2017. Controversial issues arise. Among these are the issue of standing and the values of asylum, a criminal career, child custodial care, foreign deaths, fiscal and labor market effects, and distributional weighting. Sixteen unique shadow prices (imputed marginal value) are computed. Those shadow pries are combined with proportions and levels of border management outcomes. The aggregate result is not only a large expected present value net benefit per year from managed outcomes of $46.6 billion but also a large residual unmanaged annual cost of $23.7 billion. Significant uncertainty exists, but estimated net benefits remain positive.

Estimates of the elasticity of the marginal utility of income are necessary for determining distributional weights to correct for diminishing marginal utility of income, which is particularly important in light of increasing concern about accounting for distributional impacts in regulatory review. The elasticity is also necessary for computing the social discount rate using the Ramsey formula. Despite many attempts to estimate the elasticity of the marginal utility of income, considerable uncertainty exists about the magnitude of this key parameter. In this paper, we use meta-analysis of estimates of the elasticity from the US and UK to shed light on the appropriate elasticity values to use for both distributional weighting and discounting. Relying on our findings, we tentatively conclude that it is reasonable to base the social discount rate and distributional weights on an elasticity of 1.6, with lower- and upper-bound sensitivity testing at 1.2 and 2.0. This estimate results in distributional weights which appear plausible, and which we believe can contribute to a consensus on how to conduct distributional weighting. Moreover, the resulting social discount rate is within the range typically recommended when the Ramsey formula is used.

The world remains off-track for the sustainable development goal (SDG) target 3.4, which calls for a one-third reduction in noncommunicable diseases (NCDs) mortality by 2030. This paper presents benefit–cost analyses of various NCD interventions in low-income (LICs) and lower–middle-income (LMCs) countries. We looked at 30 interventions recommended by the Disease Control Priorities Project, including six intersectoral policies (e.g., taxes) and 24 clinical services. We used a previously published model to estimate intervention costs and benefits through 2030, discounted at 8%. We focused on interventions with benefit–cost ratios (BCRs) > 15 and their contribution toward achieving the SDG target. We found that intersectoral policies often provided great value for money, with BCRs ranging from 40 (trans-fat bans) to 100 (tobacco excise taxes). However, seven clinical interventions (e.g., basic treatment of cardiovascular disease or breast cancer) also had BCRs > 15. The overall population impact of clinical interventions over the 2023–2030 period would be much higher than that of the intersectoral policies, which can take many years to reach their peak effects. Fully implementing the best-investment interventions would accelerate progress toward SDG 3.4 everywhere, but only one in 10 countries would achieve the target. This strategy would require an additional US$ 2.4 billion annually across all LICs and LMCs. We conclude that there are several cost-beneficial opportunities to tackle NCDs in LICs and LMCs. In countries with very limited resources, the best-investment interventions could begin to address the major NCD risk factors and build greater health system capacity, with benefits continuing to accrue beyond 2030.

Government is the custodian of the most critical (and limited) factor of production, namely, land. Assuring the security of tenure, arbitrating disputes, and facilitating the transfer or sales of titles renders the land market more efficient and less volatile, attracting investors and promoting sustainable urban development. Land tenure security is also a critical government service that has repercussions on agricultural productivity, housing development, business investment, and the development of urban areas. However, land administration is mired in corruptive practices, elite capture, and inefficient allocation. Globally, only 24% of rural areas are mapped (46 in urban areas), with approximately the same percentage registered, that is, 22%. In Africa, only about 14% of rural land is formally recorded in a public register. Land tenure security can take a variety of forms depending on national regulatory frameworks that allocate land and specify its use. Success stories include transferable user certificates in China and individual land titles in Rwanda. Systematic evaluation of the evidence on tenure programs demonstrates that improved tenure security increases agricultural output (40% on average), increases urban land values (25% on average), and increases household welfare (15% on average). Other observed country-specific benefits include additional years of schooling, better academic performance, access to credit, reforestation, and improved household nutrition. The costs of establishing tenure security in Sub-Saharan Africa include the separate costs of rural (US$ 3 billion) and urban (US$ 2.2 billion) land registration; the cost of digitizing land registries and information to improve efficiency and transparency (US$ 880 million), the cost of strengthening institutions and systems to resolve land disputes and manage expropriations (US$ 960 million) over a ten-year implementation period, and land administration operations and land records maintenance over 30 years (US$ 64 billion). The net present value (8%) of costs is US$ 21.7 billion for rural land tenure and US$ 5.3 billion for urban areas. The benefits of rural land registration were based on the observed 15% household wealth effect noted in the literature. The net present value (8%) of a 30-year benefits stream is US$ 396 billion. The benefit–cost ratio of completing and modernizing land registration and improving land administration coverage and effectiveness in rural Sub-Saharan Africa is 18. The benefits of urban land registration were based on the average 25% increase in property values observed in the literature. Using housing prices for the 20 largest, Sub-Saharan African countries, the net present value (8%) of the benefits over a 30-year period is US$ 237 billion, yielding a benefit–cost ratio of 45 when the average housing price is used. When the population-weighted housing price is used, benefits are valued at US$ 160 billion, yielding a benefit–cost ratio of 30.

Greater labor migration can establish more channels for information flows, directly contributing to faster economic growth and improved innovation and work. It can also expand international remittances, which can be invested by recipient households in home countries in education, entrepreneurship, and improved and sustainable agricultural technologies. At the same time, however, increased emigration of medical professionals and technical workers from poor countries can reduce quality of local services, innovation, health status, and productivity. This analysis attempts to quantify the economic benefits and costs of permitting an immediate 10% increase in the bilateral migration of skilled workers (physicians, engineers or science, engineering, technology, and mathematics workers, and other persons with advanced educations) among the nations of the African Continental Free Trade Area and, more broadly, among 25 global regions. Economic benefits include higher migrant incomes abroad, welfare gains in destination countries associated with higher economic efficiency, spillover productivity gains, and an improved ability of the younger and more skilled working force to support the needs of the wider population, resulting in higher national production. Benefits in source countries include productivity enhancements from two sources: (a) greater access to knowledge associated with more bilateral trade and investment and (b) the ability of local households to invest remittances in productivity-enhancing activities. Welfare losses in source nations include static efficiency reductions and a worsened demographic support capability. In Africa, the benefit-cost ratios range from 3.7 to 6.9; in the global analysis, 17 to 38.

This report presents a cost–benefit analysis of increased spending on tuberculosis (TB) using impacts and costs drawn from the Global Plan to End Tuberculosis, 2023–2030. The analysis indicates that the return on TB spending is substantial with a centrally estimated benefit–cost ratio (BCR) of 46, meaning every US$ 1 invested in TB yields US$ 46 in benefits. Alternative specifications using different baselines, interventions, cost profiles, and discount rates still yield robustly high BCRs, in the range of 28–84. This report also shows that TB investment would avert substantial mortality, estimated at 27.3 million averted deaths over the 28-year period between 2023 and 2050 inclusive: almost 1 million averted deaths per year on average. Accounting for all estimated direct and indirect costs, the cost per averted death is slightly over US$ 2000. Interventions to address TB represent exceptional value-for-money.