Barbosa Euridxe, Gulela Brito, Taimo Maria A, Lopes Dino M, Offorjebe O Agatha, Risko Nicholas
Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique.
Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, USA.
Afr J Emerg Med. 2020;10(Suppl 1):S90-S94. doi: 10.1016/j.afjem.2020.05.009. Epub 2020 Jun 11.
Stroke is a leading cause of death and disability globally, with an increasing incidence in low- and middle-income countries (LMICs). The successful treatment of acute stroke requires an organized, efficient and well-resourced emergency care system. However, debate exists surrounding the prioritization of stroke treatment programs given the high costs of treatment and the increased incidence of hemorrhagic stroke in LMICs. Economic data is helpful to guide evidence-based priority setting in health systems development, particularly in low-resource settings where scarcity requires careful stewardship of resources. This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings.
The authors conducted a PRISMA style systematic review of economic evaluations of interventions to address acute stroke in LMICs. Five databases were systematically searched for articles, which were then reviewed for inclusion.
Of the 153 unique articles identified, 11 met the inclusion criteria. Four studies demonstrate the heavy economic burden on patients and households due to stroke. Two studies estimate that preventive measures are more cost-effective than acute treatments. Four studies directly examine the cost-effectiveness of thrombolysis and thrombectomy in three middle-income countries (Iran, China, and Brazil) with results ranging from roughly $2578 to $34,052 (2019 USD) per quality adjusted life-year saved. These results are similar to the cost-effectiveness ratios estimated in high-income settings. Finally, one study examined a care bundle that included acute treatment elements.
The findings reinforce the need for additional research support informed decision-making. The available evidence suggests that preventive measures should be prioritized over emergency treatment for acute stroke, particularly in settings of resource scarcity. Cost-effectiveness ratios do not compare favorably to estimates for other emergency care interventions in LMICs, such as basic emergency care training, implementation of triage systems, and basic trauma care. Cost-effectiveness is also likely to vary depending on local epidemiology. Overall, decision-makers should balance the economic evidence alongside social, political and cultural priorities when making resource allocation choices.
中风是全球死亡和残疾的主要原因，在低收入和中等收入国家（LMICs）的发病率呈上升趋势。急性中风的成功治疗需要一个有组织、高效且资源充足的紧急护理系统。然而，鉴于治疗成本高昂以及LMICs中出血性中风发病率上升，围绕中风治疗项目的优先级存在争议。经济数据有助于指导卫生系统发展中基于证据的优先级设定，特别是在资源匮乏的环境中，资源稀缺需要谨慎管理资源。本系统评价调查了LMICs环境中应对急性中风干预措施成本效益的现有证据。
作者对LMICs中应对急性中风干预措施的经济评估进行了PRISMA风格的系统评价。系统检索了五个数据库中的文章，然后对其进行纳入审查。
在识别出已识别出的153篇独特文章中，11篇符合纳入标准。四项研究表明中风给患者和家庭带来沉重经济负担。两项研究估计预防措施比急性治疗更具成本效益。四项研究直接考察了三个中等收入国家（伊朗、中国和巴西）溶栓和取栓的成本效益，结果为每挽救一个质量调整生命年约2578美元至34052美元（2019年美元）。这些结果与高收入环境中估计的成本效益比率相似。最后，一项研究考察了一个包含急性治疗要素的护理包。
研究结果强化了需要更多研究支持以进行明智决策的必要性。现有证据表明，对于急性中风，应优先考虑预防措施而非紧急治疗，特别是在资源稀缺的环境中。成本效益比率与LMICs中其他紧急护理干预措施（如基础紧急护理培训、分诊系统实施和基础创伤护理）的估计值相比并不理想。成本效益也可能因当地流行病学情况而异。总体而言，决策者在做出资源分配选择时应在经济证据与社会、政治和文化优先事项之间取得平衡。
