McMaster Midwifery Research Centre, McMaster University, 1280 Main St. W., HSC 4H24, Hamilton, ON, L8S 4K1, Canada.
Department of Health Research Methods, Evidence, and Impact, Communication Research Lab (CRL) 227, McMaster University, 1280 Main Street West, Hamilton, ON, L8K 4K1, Canada.
Int J Equity Health. 2024 Aug 22;23(1):168. doi: 10.1186/s12939-024-02252-x.
Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare.
We conducted a scoping review using methods described by Arksey and O'Malley. We conducted systematic searches in eight databases and web-searches for grey literature. Two researchers independently screened results to determine eligibility for inclusion. We included economic evaluations and cost analyses of interventions targeting pregnant people and/or new parents from underserved populations in twenty high income countries. We extracted and tabulated data from included publications regarding the study setting, population, intervention, study methods, types of costs included, and data sources for costs.
Final searches were completed in May 2024. We identified 103 eligible publications describing a range of interventions, most commonly home visiting programs (n = 19), smoking cessation interventions (n = 19), prenatal care (n = 11), perinatal mental health interventions (n = 11), and substance use treatment (n = 10), serving 36 distinct underserved populations. A quarter of the publications (n = 25) reported cost analyses only, while 77 were economic evaluations. Most publications (n = 82) considered health care costs, 45 considered other societal costs, and 14 considered only program costs. Only a third (n = 36) of the 103 included studies considered long-term costs that occurred more than one year after the birth (for interventions occurring only in pregnancy) or after the end of the intervention.
A broad range of interventions targeting pregnant people and/or new parents from underserved populations have the potential to reduce health inequities in their offspring. Economic evaluations of such interventions are often at risk of underestimating the long-term benefits of these interventions because they do not consider downstream societal costs. Our consolidated list of downstream and long-term costs from existing research can inform future economic analyses of interventions targeting poorly served pregnant people and new parents. Comprehensively quantifying the downstream and long-term benefits of such interventions is needed to inform decision making that will improve health equity.
缺乏针对服务不足的围产期人群的干预措施的长期经济效益证据可能会阻碍有关资金的决策。为了优化未来研究的质量，我们研究了评估针对医疗服务获取不足的孕妇和/或新父母的干预措施的价值所使用的方法和成本。
我们使用 Arksey 和 O'Malley 描述的方法进行了范围审查。我们在八个数据库和网络搜索中进行了系统搜索，以获取灰色文献。两名研究人员独立筛选结果以确定纳入的资格。我们纳入了来自 20 个高收入国家的针对服务不足人群的孕妇和/或新父母的干预措施的经济评估和成本分析。我们从纳入的出版物中提取并列出了有关研究设置、人群、干预措施、研究方法、包括的成本类型以及成本数据来源的数据。
最终搜索于 2024 年 5 月完成。我们确定了 103 项符合条件的出版物，描述了一系列干预措施，最常见的是家访计划（n=19）、戒烟干预（n=19）、产前护理（n=11）、围产期心理健康干预（n=11）和物质使用治疗（n=10），为 36 个不同的服务不足人群提供服务。四分之一的出版物（n=25）仅报告了成本分析，而 77 篇是经济评估。大多数出版物（n=82）考虑了医疗保健成本，45 篇考虑了其他社会成本，14 篇仅考虑了项目成本。在 103 项纳入的研究中，只有三分之一（n=36）考虑了出生后一年以上（仅针对在妊娠期间发生的干预措施）或干预结束后发生的长期成本。
针对服务不足的孕妇和/或新父母的广泛干预措施有可能减少其子女的健康不平等。此类干预措施的经济评估往往存在低估这些干预措施长期效益的风险，因为它们没有考虑下游社会成本。我们从现有研究中综合列出的下游和长期成本清单可以为针对服务不足的孕妇和新父母的干预措施的未来经济分析提供信息。全面量化此类干预措施的下游和长期效益对于改善健康公平决策至关重要。
