Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.
Eur J Public Health. 2017 Aug 1;27(4):621-631. doi: 10.1093/eurpub/ckw237.
The early detection and adequate management of cardiometabolic diseases (CMD) is becoming a priority to prevent future health problems and related healthcare costs.
This study systematically reviewed the economic evaluations of screening programmes for the early detection of persons at risk for CMD.
A systematic review was conducted using MEDLINE, Web of Science, NHSEED and the CEA registry to identify relevant articles published between 1 January 2005 and 1 May 2015. Two reviewers independently selected articles, systematically extracted data and critically appraised the study quality using the Extended Consensus on Health Economic Criteria (CHEC) List.
From the initial 2820 studies identified, 17 were included. Six studies assessed whether screening would be cost-effective, seven aimed to determine the most efficient screening programme and four assessed the cost-effectiveness of existing programmes. There were 11 cost-utility analyses using quality-adjusted life years (QALYs) or disability-adjusted life years. Decision-analytic modelling (e.g. Markov model) was most frequently used (n = 10), followed by simulation models (n = 4), observational (n = 2) and trial-based (n = 1) studies. All studies assessing the cost per QALY gained of screening for cardiovascular diseases and diabetes mellitus (n = 8) were below a threshold of £30 000, while those assessing chronic kidney diseases (n = 2) were above the threshold. Conclusions: In view of the heterogeneity in study objectives, country setting, screening programmes, comparators, methodology and outcomes, it is not possible to make clear recommendations about the economic value of screening programmes for CMD. Developing further screening programmes and conducting thorough economic analysis, including usual care, is needed.
早期发现和充分管理心脏代谢疾病（CMD）正成为预防未来健康问题和相关医疗保健费用的优先事项。
本研究系统地综述了用于早期发现 CMD 高危人群的筛查计划的经济评估。
使用 MEDLINE、Web of Science、NHSEED 和 CEA 登记处，系统地检索了 2005 年 1 月 1 日至 2015 年 5 月 1 日期间发表的相关文章，以确定本研究。两名评审员独立选择文章，系统地提取数据，并使用扩展健康经济标准（CHEC）清单对研究质量进行批判性评估。
从最初确定的 2820 项研究中，有 17 项被纳入。六项研究评估了筛查是否具有成本效益，七项旨在确定最有效的筛查计划，四项评估了现有计划的成本效益。有 11 项成本效用分析使用了质量调整生命年（QALY）或残疾调整生命年。决策分析模型（例如 Markov 模型）的使用最为频繁（n = 10），其次是模拟模型（n = 4）、观察性研究（n = 2）和试验研究（n = 1）。所有评估心血管疾病和糖尿病筛查的成本效益比（n = 8）的研究均低于 30000 英镑的阈值，而评估慢性肾病（n = 2）的研究则高于阈值。结论：鉴于研究目标、国家背景、筛查计划、比较、方法和结果的异质性，不可能对 CMD 筛查计划的经济价值提出明确的建议。需要进一步开发筛查计划并进行全面的经济分析，包括常规护理。
