Schwappach David Lb, Boluarte Till A, Suhrcke Marc
Research Institute for Public Health and Addiction, Zurich, Switzerland.
Department of Health policy, University Witten-Herdecke, Witten, Germany.
Cost Eff Resour Alloc. 2007 May 14;5:5. doi: 10.1186/1478-7547-5-5.
In the quest for public and private resources, prevention continues to face a difficult challenge in obtaining tangible public and political support. This may be partly because the economic evidence in favour of prevention is often said to be largely missing. The overall aim of this paper is to examine whether economic evidence in favour of prevention does exist, and if so, what its main characteristics, weaknesses and strengths are. We concentrate on the evidence regarding primary prevention that targets cardiovascular disease event or risk reduction.
We conducted a systematic literature review of journal articles published during the period 1995-2005, based on a comprehensive key-word based search in generic and specialized electronic databases, accompanied by manual searches of expert databases. The search strategy consisted of combinations of freetext and keywords related to economic evaluation, cardiovascular diseases, and primary preventive interventions of risk assessment or modification.
A total of 195 studies fulfilled all of the relevant inclusion criteria. Overall, a significant amount of relevant economic evidence in favour of prevention does exist, despite important remaining gaps. The majority of studies were cost-effectiveness-analyses, expressing benefits as "life years gained", were conducted in a US or UK setting, assessed clinical prevention, mainly drugs targeted at lowering lipid levels, and referred to subjects aged 35-64 years old with at least one risk factor.
First, this review has demonstrated the obvious lack of economic evaluations of broader health promotion interventions, when compared to clinical prevention. Second, the clear role for government to engage more actively in the economic evaluation of prevention has become very obvious, namely, to fill the gap left by private industry in terms of the evaluation of broader public health interventions and regarding clinical prevention, in light of the documented relationship between study funding and reporting of favourable results. Third, the value of greater adherence to established guidelines on economic evaluation cannot be emphasised enough. Finally, there appear to be certain methodological features in the practice of economic evaluations that might bias the choice between prevention and cure in favour of the latter.
在寻求公共和私人资源的过程中，预防工作在获得切实的公众和政治支持方面仍面临艰巨挑战。这可能部分是因为人们常说，支持预防的经济证据大多缺失。本文的总体目标是研究是否存在支持预防的经济证据，如果存在，其主要特征、弱点和优势是什么。我们专注于针对心血管疾病事件或风险降低的一级预防的证据。
我们基于在通用和专业电子数据库中进行的全面关键词搜索，并辅以专家数据库的手动搜索，对1995年至2005年期间发表的期刊文章进行了系统的文献综述。搜索策略包括与经济评估、心血管疾病以及风险评估或修正的一级预防干预相关的自由文本和关键词组合。
共有195项研究符合所有相关纳入标准。总体而言，尽管仍存在重要差距，但确实存在大量支持预防的相关经济证据。大多数研究是成本效益分析，将益处表示为“获得的生命年”，在美国或英国进行，评估临床预防，主要是针对降低血脂水平的药物，并涉及年龄在35至64岁、至少有一个风险因素的受试者。
首先，与临床预防相比，本次综述表明明显缺乏对更广泛的健康促进干预措施的经济评估。其次，政府更积极地参与预防经济评估的明确作用变得非常明显，即鉴于研究资金与有利结果报告之间的记录关系，填补私营行业在更广泛的公共卫生干预措施评估和临床预防方面留下的空白。第三，必须充分强调更严格遵守既定经济评估指南的价值。最后，经济评估实践中似乎存在某些方法学特征，可能会使预防与治疗之间的选择偏向后者。
