Bakhtiari Ahad, Takian Amirhossein, Majdzadeh Reza, Haghdoost Ali Akbar
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
BMC Public Health. 2020 Mar 14;20(1):333. doi: 10.1186/s12889-020-8446-x.
The WHO's "best buys" and other recommended interventions are a menu of policy options and cost-effective interventions for the prevention and control of major noncommunicable diseases (NCDs). The menu has six objectives, implementing which by member states is expected to promote the achievement of the nine NCD targets by 2025. In line with their context, countries can select from the menu of best buys and other recommended interventions. Iran adopted its national action plan on NCDs, 2015, including global as well as some specific goals and targets. This study had two objectives: analyzing the gaps to reach the national targets on NCDs; and prioritizing the best buys and other recommended interventions based on multi-criteria decision-making (MCDA) method for the context of Iran.
This is a mixed-methods study. We used qualitative textual evidence (documentary content analysis) and MCDA for prioritization of interventions based on five criteria, including a number of people to be potentially affected by the intervention, cost-effectiveness of the intervention, attributable burden (DALY per 100,000), hospitalization and variations among income levels. Data related to five criteria for each intervention were extracted from national studies and relevant international organizations. The weight of each criterion determines based on the opinions of national experts.
Out of 105 actions and interventions recommended by WHO, only 12 of them were not on the national agenda in Iran, while the six missed interventions were related to objective number 4. Only one of the best buys Group's interventions was not targeted (vaccination against human papillomavirus, two doses of 9-13-year-old girls), for which arrangements are being made for the implementation. Encouraging and educating healthy dietary habits and increasing public awareness about the side effects of smoking and exposure to second-hand smoke, e.g., through mass media campaigns, are among the interventions in need of serious prioritization. The priority of interventions was independently calculated in the area of risk factors and clinical preventive interventions.
Due to limited resources, low and middle-income countries (LMICs) need to identify and prioritize more cost-effective and more equitable interventions to combat the NCD epidemic. Based on our findings, we advocate more investment in the mass and social media campaigns to promote a healthy diet, avoid tobacco use, as well as the inclusion of some effective clinical preventive interventions into the national action plan, along the long pathway to tackle NCDs and ultimately reach sustainable health development in Iran. The use of the MCDA approach assisted us in formulating a simultaneous use of efficiency and equity, and other indices for prioritizing the interventions.
世界卫生组织的“最佳选择”及其他推荐干预措施是用于预防和控制主要非传染性疾病（NCDs）的一系列政策选项和具有成本效益的干预措施。该清单有六个目标，各成员国实施这些目标有望推动到2025年实现九个非传染性疾病目标。各国可根据自身情况从最佳选择及其他推荐干预措施清单中进行挑选。伊朗通过了其2015年非传染性疾病国家行动计划，包括全球目标以及一些具体目标。本研究有两个目的：分析在实现国家非传染性疾病目标方面存在的差距；并基于多标准决策分析（MCDA）方法，针对伊朗的情况对最佳选择及其他推荐干预措施进行优先排序。
这是一项混合方法研究。我们使用定性文本证据（文献内容分析）以及MCDA，基于五个标准对干预措施进行优先排序，这五个标准包括可能受干预措施影响的人数、干预措施的成本效益、可归因负担（每10万人伤残调整生命年数）、住院情况以及不同收入水平之间的差异。每项干预措施的五个标准相关数据均从国内研究和相关国际组织中提取。每个标准的权重根据国内专家的意见确定。
在世界卫生组织推荐的105项行动和干预措施中，伊朗国家议程上未列出的仅有12项，而六项未涵盖的干预措施与目标4相关。最佳选择组的干预措施中只有一项未被纳入（针对9至13岁女孩的两剂人乳头瘤病毒疫苗接种），目前正在为实施该措施做出安排。鼓励和教育健康的饮食习惯，以及通过大众媒体宣传等方式提高公众对吸烟和接触二手烟副作用的认识，是需要认真进行优先排序的干预措施。在风险因素和临床预防干预领域独立计算了干预措施的优先级。
由于资源有限，低收入和中等收入国家（LMICs）需要确定更具成本效益和更公平的干预措施并对其进行优先排序，以应对非传染性疾病流行。基于我们的研究结果，我们主张在大众和社交媒体宣传方面加大投资，以促进健康饮食、避免使用烟草，同时在伊朗应对非传染性疾病并最终实现可持续健康发展的漫长道路上，将一些有效的临床预防干预措施纳入国家行动计划。使用MCDA方法有助于我们在确定干预措施的优先顺序时同时兼顾效率和公平以及其他指标。
