背景:确定医疗保健干预措施的成本效益阈值一直是决策者面临的严峻挑战,特别是在低收入和中等收入国家。这项研究旨在估算人类发展指数(HDI)和国内生产总值(GDP)水平不同的国家避免的每个残疾调整生命年(DALY)的成本。
方法:关于DALYs的数据,人均卫生支出(HE),HDI,2000年至2016年,176个国家的人均GDP被提取出来。然后我们研究了这些变量的趋势。进行面板回归分析以探讨DALY与人均HE之间的相关性。回归模型的结果用于计算每个国家避免的每DALY成本。
结果:年龄标准化率(ASR)DALY(每100,000人口中的DALY)与人均HE呈非线性负相关,与HDI呈线性负相关。人均HE增加1%与低HDI的ASRDALY平均下降0.28、0.24、0.18和0.27%相关,中等HDI,高HDI,人类发展指数很高的国家,分别。低HDI避免的每DALY估计成本为998美元,6522美元,23,782美元和69,499美元,中等HDI,高HDI,人类发展指数很高的国家。平均而言,在低人类发展指数国家,避免的每DALY成本是人均GDP的0.34倍。在中等HDI时,高HDI,人类发展指数很高的国家,它是人均GDP的0.67、1.22和1.46倍,分别。
结论:这项研究表明,在低和中人类发展指数国家,成本效益阈值可能低于人均国内生产总值,在高和极高人类发展指数国家,成本效益阈值可能在1至2之间。
BACKGROUND: Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This
study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).
METHODS: The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.
RESULTS: Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.
CONCLUSIONS: This
study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.