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Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review

BACKGROUND: Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for th...

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Autores principales: Watson, Samuel I., Sahota, Harvir, Taylor, Celia A., Chen, Yen-Fu, Lilford, Richard J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992822/
https://www.ncbi.nlm.nih.gov/pubmed/29930989
http://dx.doi.org/10.1186/s41256-018-0073-z
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author Watson, Samuel I.
Sahota, Harvir
Taylor, Celia A.
Chen, Yen-Fu
Lilford, Richard J.
author_facet Watson, Samuel I.
Sahota, Harvir
Taylor, Celia A.
Chen, Yen-Fu
Lilford, Richard J.
author_sort Watson, Samuel I.
collection PubMed
description BACKGROUND: Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for these interventions. We aimed to review the scope, quality, and findings of economic evaluations of service delivery interventions in LMICs. METHODS: We searched PUBMED, MEDLINE, EconLit, and NHS EED for studies published between 1st January 2000 and 30th October 2016 with no language restrictions. We included all economic evaluations that reported incremental costs and benefits or summary measures of the two such as an incremental cost effectiveness ratio. Studies were grouped by both disease area and outcome measure and permutation plots were completed for similar interventions. Quality was judged by the Drummond checklist. RESULTS: Overall, 3818 potentially relevant abstracts were identified of which 101 studies were selected for full text review. Thirty-seven studies were included in the final review. Twenty-three studies reported on interventions we classed as “changing by whom and where care was provided”, specifically interventions that entailed task-shifting from doctors to nurses or community health workers or from facilities into the community. Evidence suggests this type of intervention is likely to be cost-effective or cost-saving. Nine studies reported on quality improvement initiatives, which were generally found to be cost-effective. Quality and methods differed widely limiting comparability of the studies and findings. CONCLUSIONS: There is significant heterogeneity in the literature, both methodologically and in quality. This renders further comparisons difficult and limits the utility of the available evidence to decision makers.
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spelling pubmed-59928222018-06-21 Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review Watson, Samuel I. Sahota, Harvir Taylor, Celia A. Chen, Yen-Fu Lilford, Richard J. Glob Health Res Policy Review BACKGROUND: Low and middle income countries (LMICs) face severe resource limitations but the highest burden of disease. There is a growing evidence base on effective and cost-effective interventions for these diseases. However, questions remain about the most cost-effective method of delivery for these interventions. We aimed to review the scope, quality, and findings of economic evaluations of service delivery interventions in LMICs. METHODS: We searched PUBMED, MEDLINE, EconLit, and NHS EED for studies published between 1st January 2000 and 30th October 2016 with no language restrictions. We included all economic evaluations that reported incremental costs and benefits or summary measures of the two such as an incremental cost effectiveness ratio. Studies were grouped by both disease area and outcome measure and permutation plots were completed for similar interventions. Quality was judged by the Drummond checklist. RESULTS: Overall, 3818 potentially relevant abstracts were identified of which 101 studies were selected for full text review. Thirty-seven studies were included in the final review. Twenty-three studies reported on interventions we classed as “changing by whom and where care was provided”, specifically interventions that entailed task-shifting from doctors to nurses or community health workers or from facilities into the community. Evidence suggests this type of intervention is likely to be cost-effective or cost-saving. Nine studies reported on quality improvement initiatives, which were generally found to be cost-effective. Quality and methods differed widely limiting comparability of the studies and findings. CONCLUSIONS: There is significant heterogeneity in the literature, both methodologically and in quality. This renders further comparisons difficult and limits the utility of the available evidence to decision makers. BioMed Central 2018-06-08 /pmc/articles/PMC5992822/ /pubmed/29930989 http://dx.doi.org/10.1186/s41256-018-0073-z Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Watson, Samuel I.
Sahota, Harvir
Taylor, Celia A.
Chen, Yen-Fu
Lilford, Richard J.
Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title_full Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title_fullStr Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title_full_unstemmed Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title_short Cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
title_sort cost-effectiveness of health care service delivery interventions in low and middle income countries: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992822/
https://www.ncbi.nlm.nih.gov/pubmed/29930989
http://dx.doi.org/10.1186/s41256-018-0073-z
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