Banke-Thomas Aduragbemi, Madaj Barbara, Kumar Shubha, Ameh Charles, van den Broek Nynke
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
BMJ Glob Health. 2017 Jul 28;2(2):e000310. doi: 10.1136/bmjgh-2017-000310. eCollection 2017.
Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both 'economy' and 'efficiency' can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case-control studies or randomised controlled trials can be used to assess 'effectiveness'. To assess 'cost-effectiveness', cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such 'economy' and 'efficiency' are relatively easy to assess. However, 'effectiveness' and 'cost-effectiveness' which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help.
为应对对孕产妇和新生儿健康干预措施进行性价比（VfM）论证的需求不断增加的情况，且鉴于同行评审文献中缺乏VfM分析，本文回顾了VfM的组成部分和方法，对其适用性、优点和缺点进行了批判，并提出了如何改进VfM评估。VfM包括四个组成部分：经济性、效率、有效性和成本效益。“经济性”和“效率”都可以通过利用从项目会计数据或通用成本数据库获得的成本进行详细成本分析来评估。前后研究、病例对照研究或随机对照试验可用于评估“有效性”。为评估“成本效益”，适用成本效益分析（CEA）、成本效用分析（CUA）、成本效益分析（CBA）或社会投资回报率（SROI）分析。一般来说，成本可以从项目会计数据或现有的通用成本数据库中获得。因此，“经济性”和“效率”相对容易评估。然而，需要建立反事实的“有效性”和“成本效益”则更难确定。提出的替代方法是将CEA或CUA与评估其他VfM组成部分的工具相结合，或独立使用CBA或SROI，以加强VfM评估。还应评估公平性、可持续性、可扩展性和文化可接受性等贯穿各领域的主题，因为它们为解释VfM评估提供了关键的背景信息。选择评估方法时，应考虑目的、数据可用性、需要研究结果的利益相关者以及项目受益人的观点。实施者和研究者应共同努力提高评估质量。围绕定义、方法和待评估的有效性措施进行标准化将有所帮助。
