George Lin, Kalin Werner, Ada Alqunaiebet, Mariam M Hamza, Norah Alkanhal, Reem F Alsukait, Amaal Alruwaily, Severin Rakic, Volkan Cetinkaya, Christopher H Herbst, Tracy Kuo Lin
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引用次数: 0
摘要
背景：慢性病或非传染性疾病 (NCD) 是一种病程较长的疾病，通常受到遗传、生理、环境和行为等多个变量复杂相互作用的影响和促成。这些疾病会导致死亡、残疾和后续的医疗费用。中小学环境为提供成本相对较低、有效的干预措施以改善公共卫生成果提供了机会。然而，目前还缺乏有关这些干预措施成本效益的系统性证据：我们在四个数据库（PubMed/Medline、Cochrane、Embase 和 Web of Science）中系统地检索了已发表的有关学校环境中慢性病干预措施成本效益的研究。如果研究评估了任何慢性病或非传染性疾病的干预措施，在学校环境中进行，进行了全面的成本效益分析，并且有英语、西班牙语或法语版本，则符合纳入条件：在对数据库进行初步搜索时，我们发现了 1029 篇文章，经过筛选，有 33 项研究被纳入最终分析。最常用的疗效衡量标准是总结性疗效单位，如质量调整生命年（QALYs）（22 篇文章；67%）或残疾调整生命年（DALYs）（4 篇文章；12%）。干预措施所针对的最常见健康状况是超重和肥胖。几乎所有基于学校的干预措施都具有成本效益（30 篇文章；81%）：我们的综述发现，有证据支持一些针对非传染性疾病的具有成本效益的校本干预措施，这些措施主要集中在疫苗接种、常规体育锻炼和补充剂提供干预等方面。相反，许多针对心理健康的课堂认知行为疗法和某些针对肥胖症的多成分干预措施并不具有成本效益。
The cost-effectiveness of school-based interventions for chronic diseases: a systematic review.
Background: Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions.
Methods: We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French.
Results: Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%).
Conclusion: Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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