Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA.
BMJ Glob Health. 2020 Feb 4;5(2):e001850. doi: 10.1136/bmjgh-2019-001850. eCollection 2020.
Since resources are finite, investing in services that produce the highest health gain 'return on investment' is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.
We used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008-2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.
We identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.
Our findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.
由于资源有限，投资于能产生最高健康收益“投资回报”的服务至关重要。我们评估了中低收入国家（LMIC）在其国家战略卫生计划中纳入节省成本干预措施的程度。
我们使用塔夫茨医疗中心全球卫生成本效益分析登记处，这是一个包含英语成本效益分析的开源数据库，以识别在过去 10 年（2008-2017 年）中发表的针对 LMIC 节省成本的卫生干预措施的分析。为了评估各国在其最新国家卫生战略计划中是否优先考虑节省成本的干预措施，我们确定了 10 个在疾病负担全球尺度上得分最高的撒哈拉以南非洲国家，并审查了它们的国家卫生重点计划。
我们确定了 392 项针对 LMIC 的研究（63%），这些研究报告了 3315 个每残疾调整生命年（DALY）成本比，其中 207 个（6%）表示干预措施被报告为节省成本。其中一半以上（53%）针对撒哈拉以南非洲。在我们调查的撒哈拉以南非洲的 10 个国家中，58%（79/137）的节省成本干预措施与国家计划中确定的优先事项相对应。对齐度从南非的 95%（21/22 个优先考虑节省成本的比值）到喀麦隆的 17%（2/12 个优先考虑节省成本的比值）不等。人乳头瘤病毒疫苗接种在 70%（7/10）的国家卫生重点计划中被列为重点，而 40%（4/10）的国家明确包括梅毒产前血清学筛查。艾滋病毒预防和治疗是大多数国家卫生计划的重点，而 40%（2/5）的国家主要概述了丝虫病的努力。在我们的 45 种独特干预措施样本中，36%的干预措施（16/45）包括与干预措施实施直接相关的费用。
我们的研究结果表明，在撒哈拉以南非洲国家的样本中，国家和疾病领域在将经济证据纳入国家卫生重点计划方面存在很大差异。为了使卫生经济数据更加突出，成本效益分析的作者必须更加努力反映实施成本和其他可能限制医疗保健提供的因素。
