Bankolé Adissa, Conombo Blanchard, Légaré France, Laberge Maude
Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Canada.
VITAM Centre de recherche en santé durable - Université Laval, Québec, Québec, Canada.
BMC Health Serv Res. 2025 Jul 1;25(1):836. doi: 10.1186/s12913-025-13024-w.
Scaling seeks to extend the benefits of evidence-based interventions (EBIs) to larger populations, and often with the hope of achieving economies of scale. However, little is known about scaling costs. Our goal was to find scaling studies that focused on economic evaluations of scaling, their characteristics and the methods they applied.
We performed a systematic review informed by the Joanna Briggs Institute and PRISMA reporting guidelines. We included all studies that conducted a full or partial economic evaluation of scaling an EBI in healthcare, applicable to any individual or organization in any country and setting. We included all study designs and imposed no restrictions on language. We conducted searches in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception until November 12, 2024, including grey literature. Pairs of independent reviewers identified eligible studies and extracted data on study characteristics, scaling strategies, characteristics of economic evaluations and methods used. The methodological quality of included studies was evaluated using the British Medical Journal Checklist. Results were summarized using narrative synthesis.
Of 8,936 unique citations, thirteen studies meet our inclusion criteria: ten cost-effectiveness and three cost-analysis studies. Studies were performed in lower- or middle-income countries (LMIC) as well as in high-income countries and covered EBIs for infectious diseases, mental health, and colorectal cancer. All reported direct costs (e.g., health professional training costs) and indirect costs (e.g., capital costs) associated with scaling strategies. Four studies were of high quality, eight of moderate quality and one of poor quality.
With the increased interest in scaling EBIs in health, there is an urgent need for more evaluations of costs associated with scaling, both in LMIC and in high-income countries, and a need for rigour in how these evaluations are performed.
扩大规模旨在将循证干预措施（EBIs）的益处推广到更多人群，并且通常希望实现规模经济。然而，对于扩大规模的成本知之甚少。我们的目标是找到专注于扩大规模的经济评估、其特征以及所应用方法的相关研究。
我们依据乔安娜·布里格斯研究所和PRISMA报告指南进行了一项系统综述。我们纳入了所有对医疗保健领域扩大循证干预措施规模进行全面或部分经济评估的研究，适用于任何国家和环境中的任何个人或组织。我们纳入了所有研究设计，且对语言不设限制。我们在Medline、科学网、Embase、考科蓝图书馆数据库、PEDE、EconLIT、INHATA中进行了从其创建至2024年11月12日的检索，包括灰色文献。由两名独立评审员确定符合条件的研究，并提取有关研究特征、扩大规模策略、经济评估特征和所使用方法的数据。使用《英国医学杂志》检查表评估纳入研究的方法学质量。结果采用叙述性综合进行总结。
在8936条独特的文献引用中，有13项研究符合我们的纳入标准：10项成本效益研究和3项成本分析研究。这些研究在低收入或中等收入国家（LMIC）以及高收入国家开展，涵盖了针对传染病、心理健康和结直肠癌的循证干预措施。所有研究都报告了与扩大规模策略相关的直接成本（如卫生专业人员培训成本）和间接成本（如资本成本）。4项研究质量高，8项中等质量，1项质量差。
随着对在卫生领域扩大循证干预措施规模的兴趣增加，迫切需要在低收入和中等收入国家以及高收入国家对与扩大规模相关的成本进行更多评估，并且需要在这些评估的实施方式上保持严谨性。
