Are vaccination programmes delivered by lay health workers cost-effective? A systematic review.
Are vaccination programmes delivered by lay health workers cost-effective? A systematic review.
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DOI：
10.1186/1478-4491-7-81
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发表时间：
2009-11-03
影响因子：
4.5
通讯作者：
Scheel IB
中科院分区：
文献类型：
--
作者：
Corluka A;Walker DG;Lewin S;Glenton C;Scheel IB
最近更新的科克伦系统评价非专业或社区卫生工作者（LHWs）在初级和社区卫生保健中的作用得出结论，LHWs干预措施可能会在促进儿童接种疫苗方面带来有希望的益处。然而，对让医务工作者参与疫苗接种计划的成本和成本效益的理解仍然很差。本文回顾了涉及LHWs的疫苗接种计划干预的成本和成本效益。如果标题、关键词或摘要包含与“非专业卫生工作者”、“疫苗接种”和“经济学”相关的术语，则检索文章。还检索了评估纳入的研究的参考文献列表，并尝试联系科克伦综述中纳入的所有研究的作者。在评估全文文章的合格性后纳入研究。然后根据一组背景和技术特征对纳入的研究进行审查。在确定的2616项记录中，只有3项研究完全符合纳入标准，而另外11项研究由于包含一些成本数据而被保留。从方法上讲，这些研究很有说服力，但没有充分解决负担能力和可持续性问题，而且在环境和LHW结果方面差异很大，限制了它们的可比性。没有足够的数据可以得出任何关于LHW干预措施促进疫苗接种的成本效益的结论。研究主要侧重于健康成果，并在一定程度上说明了社区的体制特点，如治理和财政支助来源，如何影响可持续性。纳入的研究表明，传统的经济评价，特别是成本效益分析，一般过于狭隘地集中在健康结果，特别是在疫苗接种的推广和提供初级卫生保健一级的LHWs。当局应进一步研究涉及母婴健康院的防疫注射计划的成本和成本效益，而这些研究应采用更广泛和更全面的方法。
A recently updated Cochrane systematic review on the effects of lay or community health workers (LHWs) in primary and community health care concluded that LHW interventions could lead to promising benefits in the promotion of childhood vaccination uptake. However, understanding of the costs and cost-effectiveness of involving LHWs in vaccination programmes remains poor. This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving LHWs. Articles were retrieved if the title, keywords or abstract included terms related to 'lay health workers', 'vaccination' and 'economics'. Reference lists of studies assessed for inclusion were also searched and attempts were made to contact authors of all studies included in the Cochrane review. Studies were included after assessing eligibility of the full-text article. The included studies were then reviewed against a set of background and technical characteristics. Of the 2616 records identified, only three studies fully met the inclusion criteria, while an additional 11 were retained as they included some cost data. Methodologically, the studies were strong but did not adequately address affordability and sustainability and were also highly heterogeneous in terms of settings and LHW outcomes, limiting their comparability. There were insufficient data to allow any conclusions to be drawn regarding the cost-effectiveness of LHW interventions to promote vaccination uptake. Studies focused largely on health outcomes and did illustrate to some extent how the institutional characteristics of communities, such as governance and sources of financial support, influence sustainability. The included studies suggest that conventional economic evaluations, particularly cost-effectiveness analyses, generally focus too narrowly on health outcomes, especially in the context of vaccination promotion and delivery at the primary health care level by LHWs. Further studies on the costs and cost-effectiveness of vaccination programmes involving LHWs should be conducted, and these studies should adopt a broader and more holistic approach.
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5.4
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