Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Eur J Epidemiol. 2015 Apr;30(4):251-77. doi: 10.1007/s10654-014-9984-2. Epub 2015 Jan 18.
The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs. 30 studies reported the economic impact of NCDs on healthcare budgets and 13 on national income. Healthcare expenditure for cardiovascular disease (12-16.5 %) was the highest; other NCDs ranged between 0.7 and 7.4 %. NCD-related health costs vary across the countries, regions, and according to type of NCD. Additionally, there is an increase in costs with increased severity and years lived with the disease. Low- and middle-income (LMI) countries were the focus of just 16 papers, which suggests an information shortage concerning the true economic burden of NCDs in these countries. NCDs pose a significant financial burden on healthcare budgets and nations' welfare, which is likely to increase over time. However further work is required to standardize more consistently the methods available to assess the economic impact of NCDs and to involve (hitherto under-addressed) LMI populations across the globe.
非传染性疾病(NCDs)对人群的影响不仅限于健康不良和死亡,还会带来巨大的财政后果。本系统评价和荟萃分析旨在评估 NCDs(包括冠心病、中风、2 型糖尿病、癌症(肺癌、结肠癌、宫颈癌和乳腺癌)、慢性阻塞性肺疾病和慢性肾脏病)对宏观经济层面(医疗保健支出和国民收入)的影响。检索了截止到 2014 年 11 月 6 日的 Medline、Embase 和 Google Scholar 等医学数据库。为进一步确定合适的研究,我们还检索了纳入研究的参考文献,并联系了该领域的专家。我们纳入了在成年人中进行的评估 NCDs 对医疗保健支出和国民收入的经济后果的随机对照试验、系统评价、队列研究、病例对照研究、横断面研究、建模研究和生态学研究,语言不限。所有的摘要和全文选择均由两位独立的评审员进行。任何分歧均通过共识或第三位评审员的咨询解决。两位独立的评审员使用预先设计的数据收集表提取数据。研究评估了以下至少一种结果指标的至少一种选定 NCDs 的影响:医疗保健支出、国民收入、医院支出、国内生产总值(GDP)、国民生产总值、国民净收入、调整国民收入、总费用、直接费用、间接费用、住院费用、门诊费用、人均医疗保健支出、总体经济结果、一国生产水平的资本损失、经济增长、人均国内生产总值(人均收入)、国内生产总值变化百分比、集约增长、外延增长、就业、政府直接支出和非政府支出。从 4364 篇参考文献中,有 153 篇符合我们的纳入标准。大多数研究都集中在 NCDs 的医疗保健相关成本上。30 项研究报告了 NCDs 对医疗保健预算的经济影响,13 项研究报告了对国民收入的影响。心血管疾病的医疗保健支出最高(12-16.5%);其他 NCDs 的范围在 0.7 到 7.4%之间。NCD 相关的健康成本因国家、地区和 NCD 类型而异。此外,随着疾病的严重程度和生存年限的增加,成本也会增加。仅有 16 篇论文关注中低收入国家(LMICs),这表明这些国家 NCDs 的真实经济负担信息不足。NCDs 给医疗保健预算和国家福利带来了重大的财政负担,而且这种负担随着时间的推移可能会增加。然而,需要进一步的工作来更一致地标准化评估 NCDs 经济影响的方法,并在全球范围内涉及(迄今被忽视的)低收入和中等收入国家的人群。