手术的成本效益及其对全球健康的政策意义：系统评价与分析。

Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis.

机构信息

Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA.

出版信息

Lancet Glob Health. 2014 Jun;2(6):e334-45. doi: 10.1016/S2214-109X(14)70213-X. Epub 2014 May 21.

DOI:10.1016/S2214-109X(14)70213-X

PMID:25103302

Abstract

BACKGROUND: The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery. METHODS: We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US$. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist. FINDINGS: Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision ($13·78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations ($12·96-25·93 per DALY) and bednets for malaria prevention ($6·48-22·04 per DALY). Median CERs of cleft lip or palate repair ($47·74 per DALY), general surgery ($82·32 per DALY), hydrocephalus surgery ($108·74 per DALY), and ophthalmic surgery ($136 per DALY) were similar to that of the BCG vaccine ($51·86-220·39 per DALY). Median CERs of caesarean sections ($315·12 per DALY) and orthopaedic surgery ($381·15 per DALY) are more favourable than those of medical treatment for ischaemic heart disease ($500·41-706·54 per DALY) and HIV treatment with multidrug antiretroviral therapy ($453·74-648·20 per DALY). INTERPRETATION: Our findings suggest that many essential surgical interventions are cost-effective or very cost-effective in resource-poor countries. Quantification of the economic value of surgery provides a strong argument for the expansion of global surgery's role in the global health movement. However, economic value should not be the only argument for resource allocation--other organisational, ethical, and political arguments can also be made for its inclusion.

摘要

背景：人们可能认为手术昂贵且复杂，这可能成为其在全球卫生工作中广泛应用的障碍。我们对评估低收入和中等收入国家外科干预措施的成本效益研究进行了系统评价和分析，以帮助量化手术的潜在价值。方法：我们在 Medline 上检索了 1996 年 1 月 1 日至 2013 年 1 月 31 日期间发表的所有相关文章，并检索了检索到的文章的参考文献列表。我们将所有结果转换为 2012 年的美元。我们使用 10 分制 Drummond 清单提取成本效益比（CER）并评估经济评估的方法质量。发现：在确定的 584 项研究中，有 26 项符合全部纳入标准。这些研究共提供了 7 类外科干预措施的 121 个独立 CER。包皮环切术的中位 CER（每残疾调整生命年 13.78 美元）与标准疫苗（每残疾调整生命年 12.96-25.93 美元）和疟疾预防用蚊帐（每残疾调整生命年 6.48-22.04 美元）相似。唇裂或腭裂修复术的中位 CER（每残疾调整生命年 47.74 美元）、普外科手术的中位 CER（每残疾调整生命年 82.32 美元）、脑积水手术的中位 CER（每残疾调整生命年 108.74 美元）和眼科手术的中位 CER（每残疾调整生命年 136 美元）与卡介苗疫苗（每残疾调整生命年 51.86-220.39 美元）相似。剖宫产术的中位 CER（每残疾调整生命年 315.12 美元）和矫形外科手术的中位 CER（每残疾调整生命年 381.15 美元）优于缺血性心脏病的药物治疗（每残疾调整生命年 500.41-706.54 美元）和多药物抗逆转录病毒疗法治疗艾滋病毒（每残疾调整生命年 453.74-648.20 美元）。解释：我们的研究结果表明，在资源匮乏的国家，许多基本的外科干预措施具有成本效益或非常具有成本效益。对手术经济价值的量化为扩大全球手术在全球卫生运动中的作用提供了强有力的论据。然而，经济价值不应该是资源分配的唯一论据——还可以提出其他组织、伦理和政治论据来支持其纳入。