Evaluating the Cost to Save A Life: U.S. vs. World

October 07, 2016

Where should you focus your charitable giving, home or away? The PIF Foundation regularly faces this dilemma when deciding how to distribute our charitable support. We certainly have a position, which is evident from our programs, but we also want our supporters to have enough information to draw their own conclusion. All of our programs are backed by in-depth analysis, a proven track record, and clear vision for the future. But how do these programs measure up to resources distributed by programs that do work right here in the U.S.?

According to the Center for Disease Control and Prevention the leading cause of death in the U.S. was heart disease, accounting for 614,348 deaths in 2014.1 We will use heart disease for the purpose of this comparison for a few reasons:


  • Scale: Because this issue impacts so many people, there are a vast amount of resources being devoted to interventions which should theoretically lead to more cost effectiveness over time.
  • Scope: The scope of the issue in the U.S. is comparable in scope to the worldwide malaria epidemic in terms of numbers of deaths per year.
  • Data: There is data available for comparing the cost effectiveness of heart disease interventions which is not always the case for other diseases.

Malaria, our international focus, killed approximately 438,000 people worldwide in 2015 according to the World Health Organization.2 This number is actually down around 60% globally since 2000 thanks to better access to medicine, heightened awareness, more funding, and increased interventions. Malaria has already been eradicated in some countries, and the prospect of complete eradication is real possibility in our lifetime.

While some might argue that this is not an apples to apples comparison - and we would partially agree - our goal is to have a starting point to compare the cost effectiveness of saving U.S. vs. non-U.S. lives using existing interventions. As better data becomes available we will certainly look draw from more direct comparisons.

Comparing QALYs

The quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. - Wikipedia

QALYs are often used to measure the cost effectiveness between various health interventions, creating a more level comparison between diseases that can vary widely. We will use QALYs to compare the cost effectiveness between Malaria (worldwide) and Heart Disease (U.S.) because it helps to level the playing field. Below are the QALY comparisons between LLINs as a means to prevent deaths from Malaria, and various U.S. interventions with a track record for preventing death for heart disease.



Cost Per QALY Estimate




Heart Disease

School based initiatives to promote healthy eating


Heart Disease

Pedometer and Walking Programs


Heart Disease

Screening for Diabetes based on Age


Heart Disease

Hypertension medications



Based on our research, as well as what we have seen from Givewell, the estimated cost to statistically save a live from eminent death is $3,461 using LLINs through the Against Malaria Foundation; which equates to adding approximately 50 QALYs for a person. Using the most aggressive estimate from U.S. based interventions to avoid heart disease at $900 per QALY we can easily estimate the statistical cost of saving a life (50 QALYs). A cost of $45,000 per life saved for the most effective program to prevent heart disease tells us that the use of LLINs to save lives is 13x more effective when distributed through the Against Malaria Foundation - which is why AMF is the beneficiary of the PIF Foundation Save A Life program donations.

How does this impact your decision about where you give?

In our experience there are a large percentage of donors that tend to have a preference for helping people that are close to them, all other factors being equal. The problem we see is that all other factors are far from equal when it comes down to efficiency and impact. We encourage donors that are geographically centric to think critically about their “multiple”. In other words, how many extra lives saved would it take for you move your donation from saving local lives, to non-local lives. Would you have to know that you would save 2x as many people, 5x, 10x? Choosing to fight malaria to save the lives means that you might not be saving U.S. lives - but you would be saving 13x as many lives.

What are your thoughts? 


  1. http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
  2. http://www.who.int/features/factfiles/malaria/en/
  3. Doing Good Better (page 220)
  4. American Heart Association: Preventing Heart Disease Cost-Effective. Kristinia Fiore, MedPage Today (2011).

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