Watson Samuel I, Sahota Harvir, Taylor Celia A, Chen Yen-Fu, Lilford Richard J
Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK.
Glob Health Res Policy. 2018 Jun 8;3:17. doi: 10.1186/s41256-018-0073-z. eCollection 2018.
Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for these interventions. We aimed to review the scope, quality, and findings of economic evaluations of service delivery interventions in LMICs.
We searched PUBMED, MEDLINE, EconLit, and NHS EED for studies published between 1st January 2000 and 30th October 2016 with no language restrictions. We included all economic evaluations that reported incremental costs and benefits or summary measures of the two such as an incremental cost effectiveness ratio. Studies were grouped by both disease area and outcome measure and permutation plots were completed for similar interventions. Quality was judged by the Drummond checklist.
Overall, 3818 potentially relevant abstracts were identified of which 101 studies were selected for full text review. Thirty-seven studies were included in the final review. Twenty-three studies reported on interventions we classed as "changing by whom and where care was provided", specifically interventions that entailed task-shifting from doctors to nurses or community health workers or from facilities into the community. Evidence suggests this type of intervention is likely to be cost-effective or cost-saving. Nine studies reported on quality improvement initiatives, which were generally found to be cost-effective. Quality and methods differed widely limiting comparability of the studies and findings.
There is significant heterogeneity in the literature, both methodologically and in quality. This renders further comparisons difficult and limits the utility of the available evidence to decision makers.
低收入和中等收入国家（LMICs）面临着严重的资源限制，但疾病负担却最为沉重。关于这些疾病的有效和具有成本效益的干预措施，已有越来越多的证据基础。然而，对于这些干预措施最具成本效益的实施方法仍存在疑问。我们旨在综述低收入和中等收入国家服务提供干预措施经济评估的范围、质量和结果。
我们检索了PUBMED、MEDLINE、EconLit和NHS EED，查找2000年1月1日至2016年10月30日期间发表的研究，无语言限制。我们纳入了所有报告增量成本和效益或两者综合指标（如增量成本效益比）的经济评估。研究按疾病领域和结果指标进行分组，并为类似干预措施完成排列图。质量由德拉蒙德清单判断。
总体而言，共识别出3818篇潜在相关摘要，其中101项研究被选进行全文审查。最终审查纳入了37项研究。23项研究报告了我们归类为“改变护理提供者和地点”的干预措施，具体而言，这些干预措施涉及任务从医生转移到护士或社区卫生工作者，或从医疗机构转移到社区。证据表明，这类干预措施可能具有成本效益或节省成本。9项研究报告了质量改进举措，总体上发现这些举措具有成本效益。质量和方法差异很大，限制了研究和结果的可比性。
文献在方法和质量上存在显著异质性。这使得进一步比较变得困难，并限制了现有证据对决策者的效用。
