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Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

机译：低收入和中等收入国家心血管疾病的初级和二级预防干预：对经济评估的系统审查

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Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond's checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation.
机译：心血管疾病（CVD）是全球死亡人数的主要原因，中低收入国家（LMIC）具有最大的过早死亡率。这些国家的许多国家，特别是在撒哈拉以南非洲，都有重大的预算限制。有必要对哪些干预措施提供良好物有所值，以遏制这种CVD流行病激励这项研究。在这一系统审查中，我们包括研究报告对个体和人口的干预（药物和非药剂学）的全部经济评估，用于LMIC中成人中的CVD的初级和二次预防。搜查了几种医疗（PubMed，Embase，Scopus，科学网）和经济（Econlit，NHS EED）数据库和灰色文学。两次审查员独立完成研究和数据提取的筛选。德拉蒙德的清单和国家健康和护理学院卓越的质量评级规模被用于所有研究的质量评估，用于告知本证据综合。从4059条记录中，读取94个全文，并达到了我们纳入标准的50项研究，以获得我们的叙述合成。大多数研究来自中等收入国家，主要是高质量的。大多数是建模评估，方法中具有显着的异质性。初级预防研究占二级预防。对专注于血压，胆固醇降低和抗血小板聚集体的药理学干预进行了大多数经济评估。最多的多数是具有成本效益的。与基于个体的干预措施相比，基于人口的干预措施很少，大多数有针对性地减少进气和烟草控制策略。这些非常具有成本效益，许多节省成本。本证据综合提供了关于在LMIC中提供良好价值的当代更新。基于人口的干预措施尤其是含盐摄入和烟草控制的减少的干预措施在LMIC中具有非常成本效益，可能会产生可以再投资以改善健康和/或其他部门的经济增益。虽然这一证据与这些地区的政策有关，但决策者另外应考虑其他多部门的观点，包括预算影响，公平，负担能力和实施的考虑，同时确定资源分配优先事项。

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