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Cost-effectiveness of health care service delivery interventions in low and middle income countries : a systematic review
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Watson, Samuel I., Sahota, Harvir, Taylor, Celia A., Chen, Y-F. and Lilford, Richard (2018) Cost-effectiveness of health care service delivery interventions in low and middle income countries : a systematic review. Global Health Research and Policy, 3 (1). doi:10.1186/s41256-018-0073-z
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Official URL: http://dx.doi.org/10.1186/s41256-018-0073-z
Abstract
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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Medical care -- Developing countries, Medical care -- Developing countries -- Cost effectiveness, Medical economics, Health services accessibility -- Developing countries | ||||||
| Journal or Publication Title: | Global Health Research and Policy | ||||||
| Publisher: | BMC | ||||||
| ISSN: | 2397-0642 | ||||||
| Official Date: | 9 June 2018 | ||||||
| Dates: |
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| Volume: | 3 | ||||||
| Number: | 1 | ||||||
| DOI: | 10.1186/s41256-018-0073-z | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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