Walker Ian F, Garbe Fredrike, Wright Judy, Newell Ian, Athiraman Naveen, Khan Nida, Elsey Helen
Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
Value Health Reg Issues. 2018 May;15:12-26. doi: 10.1016/j.vhri.2017.05.003. Epub 2017 Jul 3.
More than 80% of global deaths caused by cardiovascular disease (CVD) and diabetes mellitus (DM) occur in developing countries. The burden of noncommunicable disease in South Asia is increasing rapidly.
To estimate the costs of CVD and the costs of DM to individuals and society in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.
We systematically searched six health and economic databases for studies identifying costs related to CVD or DM and their respective complications. Costs were extracted from included studies and converted to US $ for the price year 2015 to enable meaningful comparisons.
Of the 71 articles suitable for full-text review, 29 studies met the inclusion criteria. Most were cost-of-illness studies (n = 27) and were from the patient perspective (n = 23). Most collected data since 2000 (n = 23) and included data from India (n = 24). No studies included longitudinal costs at the patient level. Medical costs for routine management of CVD and DM were broadly similar. These costs escalate significantly once complications occur, which require treatment, particularly for stroke, major coronary events, and amputations. Costs are mainly borne by the individual and family. Some included studies modeled rapidly rising future costs. Most studies included had methodological weaknesses.
Marked increases in costs have been identified when complications of these chronic diseases occur, underlining the importance of secondary prevention approaches in disease management in South Asia. Higher quality studies, especially those that include longitudinal costs, are required to establish more robust cost estimates.
全球超过80%由心血管疾病（CVD）和糖尿病（DM）导致的死亡发生在发展中国家。南亚的非传染性疾病负担正在迅速增加。
估计阿富汗、孟加拉国、不丹、印度、马尔代夫、尼泊尔、巴基斯坦和斯里兰卡心血管疾病和糖尿病给个人及社会带来的成本。
我们系统检索了六个健康与经济数据库，以查找确定与心血管疾病或糖尿病及其各自并发症相关成本的研究。从纳入研究中提取成本，并将其转换为2015年价格的美元，以便进行有意义的比较。
在71篇适合全文审查的文章中，29项研究符合纳入标准。大多数是疾病成本研究（n = 27），且是从患者角度进行的研究（n = 23）。大多数研究收集的是2000年以来的数据（n = 23），并包含来自印度的数据（n = 24）。没有研究纳入患者层面的纵向成本。心血管疾病和糖尿病常规管理的医疗成本大致相似。一旦出现需要治疗的并发症，尤其是中风、重大冠状动脉事件和截肢，这些成本会大幅上升。成本主要由个人和家庭承担。一些纳入研究模拟了未来成本的快速上升。大多数纳入研究存在方法学上的弱点。
已确定这些慢性病出现并发症时成本会显著增加，这突出了二级预防方法在南亚疾病管理中的重要性。需要更高质量的研究，尤其是那些包含纵向成本的研究，以建立更可靠的成本估计。
