Mulligan Jo-Ann, Walker Damian, Fox-Rushby Julia
Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, UK.
Cost Eff Resour Alloc. 2006 Apr 3;4:7. doi: 10.1186/1478-7547-4-7.
Demographic projections suggest a major increase in non-communicable disease (NCD) mortality over the next two decades in developing countries. In a climate of scarce resources, policy-makers need to know which interventions represent value for money. The prohibitive cost of performing multiple economic evaluations has generated interest in transferring the results of studies from one setting to another. This paper aims to bridge the gap in the current literature by critically evaluating the available published data on economic evaluations of NCD interventions in developing countries.
We identified and reviewed the methodological quality of 32 economic evaluations of NCD interventions in developing countries. Developing countries were defined according to the World Bank classification for low- and lower middle-income countries. We defined NCDs as the 12 categories listed in the 1993 World Bank report Investing in Health. English language literature was searched for the period January 1984 and January 2003 inclusive in Medline, Science Citation Index, HealthStar, NHS Economic Evaluation Database and Embase using medical subheading terms and free text searches. We then assessed the quality of studies according to a set of pre-defined technical criteria.
We found that the quality of studies was poor and resource allocation decisions made by local and global policy-makers on the basis of this evidence could be misleading. Furthermore we have identified some clear gaps in the literature, particularly around injuries and strategies for tackling the consequences of the emerging tobacco epidemic.
In the face of poor evidence the role of so-called generalised cost-effectiveness analyses has an important role to play in aiding public health decision-making at the global level. Further research is needed to investigates the causes of variation among cost, effects and cost-effectiveness data within and between settings. Such analyses still need to take a broad view, present data in a transparent manner and take account of local constraints.
人口预测表明，在未来二十年中，发展中国家的非传染性疾病（NCD）死亡率将大幅上升。在资源稀缺的情况下，政策制定者需要了解哪些干预措施具有成本效益。进行多项经济评估的高昂成本引发了人们将研究结果从一个环境转移到另一个环境的兴趣。本文旨在通过批判性地评估发展中国家非传染性疾病干预措施经济评估的现有公开数据，弥合当前文献中的差距。
我们识别并审查了32项发展中国家非传染性疾病干预措施经济评估的方法质量。发展中国家根据世界银行对低收入和中低收入国家的分类来定义。我们将非传染性疾病定义为1993年世界银行报告《投资于健康》中列出的12个类别。使用医学副标题术语和自由文本搜索，在1984年1月至2003年1月期间的Medline、科学引文索引、HealthStar、NHS经济评估数据库和Embase中搜索英文文献。然后，我们根据一组预先定义的技术标准评估研究质量。
我们发现研究质量很差，地方和全球政策制定者基于这些证据做出的资源分配决策可能会产生误导。此外，我们还发现了文献中一些明显的空白，特别是在伤害以及应对新兴烟草流行后果的策略方面。
面对证据不足的情况，所谓的广义成本效益分析在协助全球层面的公共卫生决策方面可发挥重要作用。需要进一步研究以调查不同环境内部和之间成本、效果和成本效益数据差异的原因。此类分析仍需全面考虑，以透明方式呈现数据并考虑当地限制因素。
