Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries.
Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries.
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DOI：
10.1186/s10194-015-0496-6
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发表时间：
2015-02-18
期刊：
影响因子：
--
通讯作者：
Chisholm D
中科院分区：
文献类型：
--
作者：
Linde M;Steiner TJ;Chisholm D
关于减少全球偏头痛负担的干预措施的成本和效果的证据仍然很少。我们的目的是评估以证据为基础的偏头痛干预措施在人群水平上的成本效益，以及它们对减轻中低收入国家当前负担的贡献。使用标准的世卫组织成本-效果分析方法（CHOICE），我们对偏头痛的核心干预策略进行了建模，考虑了覆盖率、有效性和非依从性。环境是初级卫生保健，包括药房。我们对10年间实施的26种干预策略进行了建模。其中包括一线急性病和预防性药物，以及增加消费者教育和提供者培训的预期后果。总人口水平成本和有效性（获得的健康寿命年[HLY]）相结合，形成平均和增量成本效益比。我们在中国、印度、俄罗斯和赞比亚的一般人群中执行了该模型的运行。在所考虑的战略中，用乙酰水杨酸（ASA）治疗急性发作是迄今最具成本效益的，产生的HLY费用不到100美元。增加教育行动，每年人均成本增加1-2美分。然后，成本效益比变得稍微不那么有利，但仍然不到100美元。在阶梯式治疗模式中，每增加一个HLY，增加一种曲坦类药物，就必须支付100万美元的增量费用。对于预防，阿米替林比心得安或托吡酯更具成本效益。在低收入和中等收入国家，使用简单止痛剂进行自我管理是迄今为止最具成本效益的偏头痛治疗策略，是对卫生资源的高效利用。消费者教育和提供者培训预计将加速实现所需的覆盖面和依从性水平，执行费用相对较少，因此可以认为在经济上也具有吸引力。针对偏头痛的循证干预措施应该与针对其他对社会造成重大负担的慢性非传染性疾病的干预措施一样，对稀缺的卫生资源有同样多的要求。
Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and efficacy as well as non-adherence. The setting was primary health care including pharmacies. We modelled 26 intervention strategies implemented during 10 years. These included first-line acute and prophylactic drugs, and the expected consequences of adding consumer-education and provider-training. Total population-level costs and effectiveness (healthy life years [HLY] gained) were combined to form average and incremental cost-effectiveness ratios. We executed runs of the model for the general populations of China, India, Russia and Zambia. Of the strategies considered, acute treatment of attacks with acetylsalicylic acid (ASA) was by far the most cost-effective and generated a HLY for less than US$ 100. Adding educational actions increased annual costs by 1–2 US cents per capita of the population. Cost-effectiveness ratios then became slightly less favourable but still less than US$ 100 per HLY gained for ASA. An incremental cost of > US$ 10,000 would have to be paid per extra HLY by adding a triptan in a stepped-care treatment paradigm. For prophylaxis, amitriptyline was more cost-effective than propranolol or topiramate. Self-management with simple analgesics was by far the most cost-effective strategy for migraine treatment in low- and middle-income countries and represents a highly efficient use of health resources. Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can therefore be considered also economically attractive. Evidence-based interventions for migraine should have as much a claim on scarce health resources as those for other chronic, non-communicable conditions that impose a significant burden on societies.
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影响因子：
2.6
作者：
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7.4
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