Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Lancet Glob Health. 2024 Sep;12(9):e1526-e1533. doi: 10.1016/S2214-109X(24)00238-9.
We estimated the benefits and costs of a set of preventive interventions that could be delivered during antenatal care to prevent poor birth outcomes, including small-for-gestational-age and preterm births. We built on the assumptions and analyses underlying the Lancet Series on small vulnerable newborns (SVNs) and extended that work by incorporating more recent data, focusing only on the subset of preventive interventions, and examining a broader range of effects. A primary aim of the study was to provide a framework that decision makers could use to design programmes for women and children.
The analyses used the Lives Saved Tool (LiST) to estimate the effects and costs of scaling up the 11 preventive interventions identified in the SVN Series to improve birth outcomes. We used LiST estimates of effects and costs to estimate benefit-cost ratios (BCRs) for two intervention packages (one with interventions proven to improve birth outcomes and one with proven interventions plus interventions with potential to improve birth outcomes) and for the individual interventions in these packages for 80 low-income and middle-income countries (LMICs).
Both packages of interventions had BCRs more than 1, with a proven package BCR of 7·3 (IQR 5·3-9·1) and a proven plus potential package BCR of 5·8 (4·4-6·9). We found that in all cases the individual interventions had BCRs more than 1, there was a wide range of BCR values for the different interventions, and the BCR varied depending on package and country.
The analyses presented in this Article provide evidence that there are preventive interventions that, if scaled up in LMICs, could have a large effect on child health and provide benefits that greatly exceed the costs.
Global Affairs Canada.
我们评估了一系列可在产前护理期间提供的预防干预措施的效益和成本，以预防不良出生结局，包括小于胎龄儿和早产。我们基于小脆弱新生儿系列（SVN）的假设和分析进行构建，并通过纳入最新数据、仅关注预防干预措施的子集以及检查更广泛的影响范围，扩展了这项工作。该研究的主要目的是提供一个决策者可以用来为妇女和儿童设计方案的框架。
分析使用 Lives Saved Tool（LiST）来估计将 SVN 系列中确定的 11 项预防干预措施扩大规模以改善出生结局的效果和成本。我们使用 LiST 估计的效果和成本来估计两个干预包（一个包含已证明可改善出生结局的干预措施，另一个包含已证明的干预措施加上有潜力改善出生结局的干预措施）以及这些包中的单个干预措施在 80 个低收入和中等收入国家（LMICs）的效益成本比（BCR）。
两个干预包的 BCR 都大于 1，一个已证实的干预包的 BCR 为 7.3（IQR 5.3-9.1），一个已证实的加潜在的干预包的 BCR 为 5.8（4.4-6.9）。我们发现，在所有情况下，单个干预措施的 BCR 都大于 1，不同干预措施的 BCR 值差异很大，BCR 取决于干预措施和国家。
本文提出的分析提供了证据，证明存在一些预防干预措施，如果在 LMICs 中扩大规模，可能会对儿童健康产生重大影响，并带来大大超过成本的收益。
加拿大全球事务部。
