Chadha Anvitaa, Moore Suzanne, Kildea Sue, Gao Yu
Molly Wardaguga Institute for First Nations Birth Rights, Faculty of Health, Charles Darwin University, Brisbane, Australia.
Int J Nurs Stud Adv. 2024 Jul 25;7:100228. doi: 10.1016/j.ijnsa.2024.100228. eCollection 2024 Dec.
Preterm birth has lifelong implications, placing a burden on individuals, families, communities and the health system. While several interventions to reduce preterm birth have been economically evaluated, no scoping review has been undertaken.
To conduct a scoping review of economic evaluations of interventions that have reduced preterm birth, identify gaps in the literature and inform future health care providers and researchers on the economic value of preterm birth reduction interventions.
Databases such as PubMed, Cumulative Index to Nursing and Allied Health Literature, EBSCO, Medline (OVID), EMBASE, NHS Health Technology Assessment, the Cost-Effectiveness Analysis Registry, and the NHS Economic Evaluation Database and grey literature were comprehensively searched for economic evaluations of interventions that reduced preterm birth conducted since 2000. Items included: preterm birth reduction, intervention, method of economic evaluation, time-horizon of analysis, study population, perspective of evaluation, effectiveness, and costs. Review processes were undertaken by two reviewers, and disagreements were resolved by the larger team.
Fifteen publications met the inclusion criteria, including pharmacological interventions (5), telemedicine (1), diagnostic procedures (2), public and community health (2), prenatal care and nutrition (2), father's involvement (1), doula care (1) and a comprehensive maternity service redesign (1). Variations were observed in study design, time-horizon, study population and method of evaluation. Most studies (n = 13) adopted either a healthcare payer, provider, or system perspective. Shorter timehorizons for analysis were adopted in all studies, except one that conducted a lifetime economic evaluation. All included interventions, except one, were found to be costeffective, cost-beneficial or led to cost-savings.
Despite preterm birth placing a high economic burden on health systems and society, we found a dearth of long-term economic evaluations of prevention and reduction initiatives. Future research on preterm birth reduction initiatives should include economic evaluations.
早产会产生终身影响，给个人、家庭、社区和卫生系统带来负担。虽然已经对几种减少早产的干预措施进行了经济评估，但尚未进行范围综述。
对减少早产干预措施的经济评估进行范围综述，找出文献中的空白，并让未来的医疗保健提供者和研究人员了解减少早产干预措施的经济价值。
全面检索了PubMed、护理及相关健康文献累积索引、EBSCO、Medline（OVID）、EMBASE、英国国家卫生服务体系卫生技术评估、成本效益分析登记册、英国国家卫生服务体系经济评估数据库等数据库以及灰色文献，以查找2000年以来进行的减少早产干预措施的经济评估。纳入的项目包括：减少早产、干预措施、经济评估方法、分析的时间范围、研究人群、评估视角、有效性和成本。由两名评审员进行评审过程，分歧由更大的团队解决。
15篇出版物符合纳入标准，包括药物干预（5篇）、远程医疗（1篇）、诊断程序（2篇）、公共和社区卫生（2篇）、产前护理和营养（2篇）、父亲参与（1篇）、导乐护理（1篇）和综合产科服务重新设计（1篇）。在研究设计、时间范围、研究人群和评估方法方面存在差异。大多数研究（n = 13）采用了医疗保健支付方、提供者或系统视角。除了一项进行终身经济评估的研究外，所有研究都采用了较短的分析时间范围。除一项干预措施外，所有纳入的干预措施都被发现具有成本效益、成本效益或能带来成本节约。
尽管早产给卫生系统和社会带来了高昂的经济负担，但我们发现预防和减少早产举措的长期经济评估匮乏。未来关于减少早产举措的研究应包括经济评估。
