Economic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol
Economic evaluation of Community Level Interventions for Pre-eclampsia (CLIP) in South Asian and African countries: a study protocol
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DOI：
10.1186/s13012-015-0266-5
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发表时间：
2015-05-26
影响因子：
7.2
通讯作者：
von Dadelszen, Peter
中科院分区：
文献类型：
--
作者：
Khowaja, Asif R.;Mitton, Craig;von Dadelszen, Peter
背景：在全球范围内，妊娠期高血压疾病，特别是先兆子痫和子痫，是导致孕产妇和新生儿死亡的主要原因，并给孕妇的家庭、她们的社区和医疗保健系统带来了沉重的负担。社区一级先兆子痫干预措施(CLIP)试验评估了在社区和初级保健中心应用的一揽子护理措施，以减少因未能在社区一级发现和管理先兆子痫而导致的孕产妇和围产期残疾和死亡。对卫生干预措施的经济评估可以在确定优先事项和为扩大规模的政策决策提供信息方面发挥关键作用。目前，关于孕产妇和围产期保健领域大型、多国、基于社区的干预措施的经济评估方法的已发表文献很少。本研究方案描述了CLIP在南亚和非洲的经济评价方法的应用。方法：在试验的同时，将使用混合设计方法，即成本-效果分析(CEA)和定性专题分析，从社会角度对CLIP的经济影响进行前瞻性评价。关于卫生资源利用、费用和妊娠结局的数据将通过嵌入怀孕监测、横断面调查和预算审查的结构化问卷收集。定性数据将通过孕妇、家庭男性决策者、护理提供者和区级卫生决策者的焦点小组(FGs)收集。将考虑到来自CLIP试验的特定国家的模型投入(成本和结果)，计算卫生保健系统和社会视角的增量成本效益比。来自最终目标的新主题将为模型的设计提供参考，并有助于解释CEA的结果。讨论：世界卫生组织(WHO)强烈建议将具有成本效益的干预措施作为实现千年发展目标5(即到2015年将孕产妇死亡率从1990年水平降低75%)的一个关键方面。到目前为止，该领域的大多数成本效益研究都专门侧重于先兆子痫的诊断和临床管理，而很少关注低收入和中等收入国家的社区干预措施。这项研究方案将引起公共卫生科学家和卫生经济学家的兴趣，他们在孕产妇和围产期健康领域进行社区试验，特别是在LMICs中。
Background: Globally, hypertensive disorders of pregnancy, particularly pre-eclampsia and eclampsia, are the leading cause of maternal and neonatal mortality, and impose substantial burdens on the families of pregnant women, their communities, and healthcare systems. The Community Level Interventions for Pre-eclampsia (CLIP) Trial evaluates a package of care applied at both community and primary health centres to reduce maternal and perinatal disabilities and deaths resulting from the failure to identify and manage pre-eclampsia at the community level. Economic evaluation of health interventions can play a pivotal role in priority setting and inform policy decisions for scale-up. At present, there is a paucity of published literature on the methodology of economic evaluation of large, multi-country, community-based interventions in the area of maternal and perinatal health. This study protocol describes the application of methodology for economic evaluation of the CLIP in South Asia and Africa.Methods: A mixed-design approach i.e. cost-effectiveness analysis (CEA) and qualitative thematic analysis will be used alongside the trial to prospectively evaluate the economic impact of CLIP from a societal perspective. Data on health resource utilization, costs, and pregnancy outcomes will be collected through structured questionnaires embedded into the pregnancy surveillance, cross-sectional survey and budgetary reviews. Qualitative data will be collected through focus groups (FGs) with pregnant women, household male-decision makers, care providers, and district level health decision makers. The incremental cost-effectiveness ratio will be calculated for healthcare system and societal perspectives, taking into account the country-specific model inputs (costs and outcome) from the CLIP Trial. Emerging themes from FGs will inform the design of the model, and help to interpret findings of the CEA.Discussion: The World Health Organization (WHO) strongly recommends cost-effective interventions as a key aspect of achieving Millennium Development Goal (MDG)-5 (i.e. 75% reduction in maternal mortality from 1990 levels by 2015). To date, most cost-effectiveness studies in this field have focused specifically on the diagnostic and clinical management of pre-eclampsia, yet rarely on community-based interventions in low-and-middle-income countries (LMICs). This study protocol will be of interest to public health scientists and health economists undertaking community-based trials in the area of maternal and perinatal health, particularly in LMICs.