Ladi-Akinyemi Temitope Wunmi, Pallan Miranda, Jones Laura, Jackson Louise J
Health Economics Unit, University of Birmingham, Birmingham, UK
Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
BMJ Open. 2025 Mar 17;15(3):e092837. doi: 10.1136/bmjopen-2024-092837.
Sexual and reproductive health (SRH) programmes and services aim to prevent complications of pregnancy and childbirth, unintended pregnancies, unsafe abortions, complications caused by sexually transmitted infections, including HIV, sexual violence and impacts from avoidable cancer.
To systematically identify published economic evaluations of SRH programmes and services, assess the methods used and analyse how costs and outcomes are estimated in these studies.
Low- and middle-income countries.
Systematic review and narrative synthesis.
Eight databases were searched, including EMBASE, MEDLINE, Scopus, Health Technology Assessment, Web of Science, PsycINFO, National Health Service Economic Evaluation Database (NHS EED) and African Journals Online (AJOL) from 1998 to December 2023. The inclusion and exclusion criteria were developed using the Population, Intervention, Comparator, Outcome and Study Design framework. The review included economic evaluations alongside randomised trials and economic studies with modelling components. Study characteristics, methods and results of economic evaluations were extracted and tabulated. The quality of the studies was assessed using the Consensus Health Economic Criteria list and Philips checklists for trial-based and model-based studies, respectively. The review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the results were synthesised narratively in line with Centre for Reviews and Dissemination guidance.
7575 studies were screened and categorised. 20 studies were included in the review. The studies assessed the cost-effectiveness and costs of SRH programmes and services from an individual, healthcare or societal perspective. The main SRH programme considered was contraceptive services. The main outcome measures reported were disability-adjusted life years, quality-adjusted life years, couple years of protection and pregnancies averted. Most of the studies did not indicate the costing approach used, and many of the studies evaluated direct medical costs only. Most of the study designs were model-based with significant heterogeneity between the models. The review showed that many studies did not fulfil all of the requirements for a high-quality economic evaluation. 1 out of the 20 studies reviewed considered equity.
The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making.
CRD42023435241.
性与生殖健康（SRH）项目及服务旨在预防妊娠和分娩并发症、意外怀孕、不安全堕胎、包括艾滋病毒在内的性传播感染引起的并发症、性暴力以及可避免癌症的影响。
系统识别已发表的SRH项目及服务的经济评估，评估所使用的方法，并分析这些研究中成本和结果是如何估算的。
低收入和中等收入国家。
系统评价和叙述性综合分析。
检索了八个数据库，包括1998年至2023年12月的EMBASE、MEDLINE、Scopus、卫生技术评估、科学引文索引、PsycINFO、国家卫生服务经济评估数据库（NHS EED）和非洲在线期刊（AJOL）。纳入和排除标准是使用人群、干预措施、对照、结局和研究设计框架制定的。该评价纳入了经济评估以及随机试验和带有建模成分的经济研究。提取并列表了经济评估的研究特征、方法和结果。分别使用共识卫生经济标准清单以及基于试验和基于模型的研究的飞利浦清单评估研究质量。该评价遵循系统评价与Meta分析的首选报告项目的报告指南，并根据评价与传播中心的指南对结果进行叙述性综合分析。
筛选并分类了7575项研究。20项研究被纳入评价。这些研究从个人、医疗保健或社会角度评估了SRH项目及服务的成本效益和成本。所考虑的主要SRH项目是避孕服务。报告的主要结局指标是伤残调整生命年、质量调整生命年、夫妇保护年数和避免的怀孕数。大多数研究未表明所使用的成本核算方法，并且许多研究仅评估了直接医疗成本。大多数研究设计基于模型，模型之间存在显著异质性。评价表明，许多研究未满足高质量经济评估的所有要求。在纳入评价的20项研究中，有1项考虑了公平性。
评价揭示了评估SRH项目成本和结果的方法存在异质性。这些方法学上的局限性可能会影响公共卫生决策者利用它们来做出最优决策。
PROSPERO注册号：CRD42023435241。
