Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review
Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review
复制标题
低收入和中等收入国家计划生育干预措施的经济评价；
作者：
N. Zakiyah;Antoinette D. I. van Asselt;F. Roijmans;M. Postma
背景 低收入和中等收入国家 (L-MIC) 中大量需要计划生育的妇女缺乏现代有效方法。本研究旨在根据已发表的文献回顾这些地区扩大计划生育干预措施的潜在成本效益，并评估其对政策和未来研究的影响。研究设计 在 Medline (Pubmed)、Embase、Popline、国家经济研究局 (NBER)、EBSCOHost 和 Cochrane 图书馆等多个电子数据库中进行了系统评价。 1995 年至 2015 年间发表的对改善一个或多个低收入中等收入国家计划生育干预措施的战略进行全面经济评估的文章有资格纳入。使用叙述方法合成和分析数据，并使用综合健康经济评估报告标准（CHEERS）声明评估纳入研究的报告质量。结果 在筛选的 920 篇参考文献中，有 9 项研究符合纳入条件。六份参考文献评估了在一个或多个低收入国家中改善计划生育干预措施的成本效益，而其余参考文献则评估了撒哈拉以南非洲地区计划生育和艾滋病毒服务相结合的成本和后果。收集的证据表明，根据公认的国际成本效益基准衡量，改善计划生育干预措施在各种低收入国家中具有成本效益。在艾滋病毒高发地区，将计划生育和艾滋病毒服务结合起来既高效又具有成本效益；然而，这一证据仅得到非常有限的研究的支持。成本效益的主要驱动因素是扩大覆盖范围的成本、干预措施的有效性和国家具体因素。结论 改善低收入和中等收入国家的计划生育干预措施似乎具有成本效益。有必要进行额外的经济评估研究并提高报告质量，以产生有关成本、成本效益和负担能力的进一步证据，并支持增加计划生育方案的资金和投资。
Background A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. Study design A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Conclusion Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs.