Fattore Giovanni, Federici Carlo, Drummond Michael, Mazzocchi Mario, Detzel Patrick, Hutton Zsuzsa V, Shankar Bhavani
CeRGAS-SDA, Università Bocconi, Milano, Italy; Department of Social and Political Sciences, Università Bocconi, Milano, Italy.
Department of Social and Political Sciences, Università Bocconi, Milano, Italy.
Health Policy. 2021 Sep;125(9):1238-1246. doi: 10.1016/j.healthpol.2021.06.009. Epub 2021 Jun 29.
Nutrition interventions have specific features that might warrant modifications to the methods used for economic evaluations of healthcare interventions.
The aim of the article is to identify these features and when they challenge the use of cost-utility analysis (CUA).
A critical review of the literature is conducted and a 2 by 2 classification matrix for nutrition interventions is proposed based on 1) who the main party responsible for the implementation and funding of the intervention is; and 2) who the target recipient of the intervention is. The challenges of conducting economic evaluations for each group of nutrition interventions are then analysed according to four main aspects: attribution of effects, measuring and valuing outcomes, inter-sectorial costs and consequences and equity considerations.
CUA is appropriate for nutrition interventions when they are funded from the healthcare sector, have no (or modest) spill-overs to other sectors of the economy and have only (or mainly) health consequences. For other interventions, typically involving different government agencies, with cost implications for the private sector, with important wellbeing consequences outside health and with heterogeneous welfare effects across socio-economic groups, other economic evaluation methods need to be developed in order to offer valid guidance to policy making. For these interventions, checklists for critical appraisal of economic evaluations may require some substantial changes.
营养干预具有一些特定特征，可能需要对医疗保健干预经济评估所采用的方法进行调整。
本文旨在识别这些特征以及它们在何时对成本效用分析（CUA）的应用构成挑战。
对文献进行批判性综述，并基于以下两点为营养干预提出一个2×2分类矩阵：1）干预实施和资金提供的主要责任方是谁；2）干预的目标接受者是谁。然后根据四个主要方面分析对每组营养干预进行经济评估时面临的挑战：效果的归因、结果的测量与估值、跨部门成本与后果以及公平性考量。
当营养干预由医疗保健部门提供资金、对经济的其他部门没有（或仅有适度的）溢出效应且仅产生（或主要产生）健康后果时，成本效用分析适用于此类营养干预。对于其他干预措施，通常涉及不同政府机构，对私营部门有成本影响，在健康之外有重要的福祉后果且在社会经济群体间有不同的福利效应，需要开发其他经济评估方法以便为政策制定提供有效的指导。对于这些干预措施，经济评估的批判性评价清单可能需要进行一些重大修改。
