Chronic diseases 2 - Scaling up interventions for chronic disease prevention: the evidence
Chronic diseases 2 - Scaling up interventions for chronic disease prevention: the evidence
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DOI：
10.1016/s0140-6736(07)61697-3
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发表时间：
2007-12-08
期刊：
影响因子：
168.9
通讯作者：
Reddy, K. Srinath
中科院分区：
文献类型：
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作者：
Gaziano, Thomas A.;Galea, Gauden;Reddy, K. Srinath
预防慢性病发病率和死亡率的干预措施在低收入或中等收入国家必须具有成本效益和财政可行性，然后才能提出扩大规模的建议。我们审查的成本效益估计政策干预（包括人口为基础的和个人），可能会导致慢性病，特别是心血管疾病，糖尿病，癌症和慢性呼吸道疾病的大幅减少。我们审查了低收入、中等收入和高收入地区的数据，以及缺乏有效性或成本效益数据的政策干预证据。研究结果证实，烟草控制措施、减盐和对高危心血管疾病患者使用多种药物方案的成本效益证据有力地支持了扩大这些干预措施的可行性。进一步的评估，以确定最佳的国家政策，以实现饱和和反式脂肪的消费减少化学氢化植物油，最终可能导致心血管疾病的显着减少。最后，我们回顾了在强因果关系或极有可能获益的领域政策实施的证据，例如，减少糖尿病的个人干预措施的变化，卫生系统的重组和更广泛的政策决定。
Interventions to prevent morbidity and mortality from chronic diseases need to be cost effective and financially feasible in countries of low or middle income before recommendations for their scale-up can be made. We review the cost-effectiveness estimates on policy interventions (both population-based and personal) that are likely to lead to substantial reductions in chronic diseases-in particular, cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We reviewed data from regions of low, middle, and high income, where available, as well as the evidence for making policy interventions where available effectiveness or cost-effectiveness data are lacking. The results confirm that the cost-effectiveness evidence for tobacco control measures, salt reduction, and the use of multidrug regimens for patients with high-risk cardiovascular disease strongly supports the feasibility of the scale-up of these interventions. Further assessment to determine the best national policies to achieve reductions in consumption of saturated and trans fat-chemically hydrogenated plant oils-could eventually lead to substantial reductions in cardiovascular disease. Finally, we review evidence for policy implementation in areas of strong causality or highly probable benefit-eg, changes in personal interventions for diabetes reduction, restructuring of health systems, and wider policy decisions.