背景:全球平均体重指数的增加导致非传染性疾病(NCDs)的大幅增加,包括肯尼亚等许多低收入和中等收入国家。本文评估了肯尼亚预防和控制超重和肥胖的四种干预措施,以确定其潜在的健康和经济影响以及成本效益。
方法:我们回顾了文献,以确定效果的证据,确定干预成本,疾病费用和总医疗费用。我们使用比例多州生命表模型来量化对健康状况和医疗保健成本的潜在影响,模拟2019年肯尼亚人口的剩余寿命。从卫生系统的角度来看,评估了两项干预措施的成本效益.此外,我们使用人力资本方法来估计生产率的提高。
结果:在2019年人口的一生中,对含糖饮料征收20%税的影响估计为203,266个健康调整寿命年(HALYs)(95%不确定区间[UI]163,752-249,621),151,718HALY(95%UI55,257-250,412),用于强制千焦菜单标签,370万HALY(95%UI2,661,365-4,789,915)用于与超市食品购买方式相关的消费水平变化和1,310万HALY(95%UI11,404,317-15,152,341)用于将国家消费的变化恢复到1975年的平均能量摄入水平。这相当于每1000人4、3、73和261个HALY。终身医疗保健成本节省约为1.4亿美元(人均3美元),0.08亿美元(人均2美元),19亿美元(人均38美元)和62亿美元(人均124美元),分别。终身生产率提高约18亿美元,12亿美元,280亿美元和920亿美元。对含糖饮料征收20%的税和强制性的千焦耳菜单标签都进行了成本效益评估,并发现占主导地位(促进健康和节省成本)。
结论:评估的所有干预措施都产生了实质性的健康收益和经济效益,应考虑在肯尼亚实施。
BACKGROUND: The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness.
METHODS: We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains.
RESULTS: Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 - 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 - 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365-4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 - 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving).
CONCLUSIONS: All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya.