Singh Kavita, Chandrasekaran Ambalam M, Bhaumik Soumyadeep, Chattopadhyay Kaushik, Gamage Anuji Upekshika, Silva Padmal De, Roy Ambuj, Prabhakaran Dorairaj, Tandon Nikhil
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Clinical Trials Unit, Centre for Chronic Disease Control, New Delhi, Delhi, India.
BMJ Open. 2018 Apr 3;8(4):e017809. doi: 10.1136/bmjopen-2017-017809.
More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Hence, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. Thus, we aimed to systematically review the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia.
We searched 14 electronic databases up to August 2016. The search strategy consisted of terms related to 'economic evaluation', 'CVD', 'DM' and 'South Asia'. Per protocol two reviewers assessed the eligibility and methodological quality of studies using standard checklists, and extracted incremental cost-effectiveness ratios of interventions.
Of the 2949 identified studies, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2-5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness.
The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing, but most evidence is from India and limited to decision modelled outcomes. There is an urgent need for formal health technology assessment and policy evaluations in South Asia using local research data.
CRD42013006479.
目前超过80%的心血管疾病（CVD）和糖尿病（DM）负担位于低收入和中等收入国家。因此，迫切需要确定并实施最具成本效益的干预措施，尤其是在资源有限的南亚地区。因此，我们旨在系统评价南亚地区针对控制心血管疾病和糖尿病的个体层面、群体层面及人群层面干预措施的成本效益。
截至2016年8月，我们检索了14个电子数据库。检索策略包括与“经济评价”、“心血管疾病”、“糖尿病”及“南亚”相关的术语。按照方案，两名评审员使用标准清单评估研究的纳入资格和方法学质量，并提取干预措施的增量成本效益比。
在2949项检索到的研究中，42项符合完全纳入标准。对研究的批判性评价显示，15项质量优秀，18项质量良好，9项质量较差。大多数研究来自印度（n = 37），其次是孟加拉国（n = 3）、巴基斯坦（n = 2）和不丹（n = 1）。经济评价基于观察性研究（n = 9）、随机试验（n = 12）和决策模型（n = 21）。这些研究共评估了301项政策或临床干预措施或两者的组合。我们发现大量干预措施具有成本效益，包括初级预防（烟草税、减盐立法、食品标签和食品广告监管）以及一级和二级预防（高危组心血管疾病的多药治疗、生活方式改变和二甲双胍预防糖尿病治疗，以及每2 - 5年筛查糖尿病并发症）。这些研究中使用的分析框架和结局指标存在显著异质性，限制了荟萃分析以及根据成本效益程度对干预措施进行直接排序。
南亚地区心血管疾病和糖尿病干预措施的成本效益证据正在增加，但大多数证据来自印度且仅限于决策模型得出的结果。南亚迫切需要利用当地研究数据进行正式的卫生技术评估和政策评价。
CRD42013006479。
