高级检索

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

儿童营养干预经济学评价方法研究进展

缐孟瑶 徐海泉

缐孟瑶, 徐海泉. 儿童营养干预经济学评价方法研究进展[J]. 中国公共卫生. doi: 10.11847/zgggws1136739
引用本文: 缐孟瑶, 徐海泉. 儿童营养干预经济学评价方法研究进展[J]. 中国公共卫生. doi: 10.11847/zgggws1136739
XIAN Meng-yao, XU Hai-quan. Methods of economic evaluation on child nutrition interventions: a research progress review[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1136739
Citation: XIAN Meng-yao, XU Hai-quan. Methods of economic evaluation on child nutrition interventions: a research progress review[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1136739

儿童营养干预经济学评价方法研究进展

doi: 10.11847/zgggws1136739
基金项目: 国家自然科学基金青年科学基金(71804079);国家自然科学基金国际(地区)合作交流项目(71861147003);中国农业科学院科技创新工程(ASTIP2021);达能营养中心膳食营养研究与宣教基金(DIC2019 – 07)
详细信息
    作者简介:

    缐孟瑶(1998 – ),女,甘肃永靖人,硕士在读,研究方向:营养经济学

    通讯作者:

    徐海泉,E-mail:xuhaiquan@caas.cn

  • 中图分类号: R 153.2

Methods of economic evaluation on child nutrition interventions: a research progress review

  • 摘要: 伴随儿童营养干预评价技术的不断发展,儿童营养干预的效果评价已从单纯的健康效果评价发展至更为综合的总体效益评价。儿童营养干预项目的成本核算已细分出不同的核算方法,成本 – 效果分析中效果评价指标的选择不再局限于单一维度指标,成本 – 效用分析在评估儿童营养干预措施时建立起更为完善的分析框架并引入概率方法进行项目的成本效益估计。成本 – 效益分析因工资收入、医疗花费和生命年赋值的处理得以更全面地估计干预效益。为获得儿童营养干预后人力资本的提升程度,社会学和计量经济学方法也开始被引入,并从营养改善后儿童身高、受教育年限和认知能力的变化进行人力资本预测模型的构建。儿童营养干预的经济学评价研究正呈现出多学科深度融合的发展趋势。
  • 表  1  儿童营养干预经济学评价研究方法比较

    方法定义效果指标评价指标优点缺点
    干预成本核算法 核算公共卫生项目的直接成本及间接成本 货币单位 明确公共卫生项目的投入 缺乏对干预效果的评价,评价结果片面
    成本 – 效果分析 对单个项目(不同实施阶段或不同地区)、 ≥ 2个公共卫生项目所投入的成本与其所带来的健康效果进行比较的方法[20] BMI、BMI-Z、贫血
    率等
    成本 – 效果比、增量成本效果比 计算简便,可以直观比较目标明确的干预项目(如降低贫血率、肥胖率) 效果指标单一且存在不确定因素,难以全面反映干预效[20,48]
    成本 – 效用分析 通过比较公共卫生项目的投入和经生命质量调整的健康产出,以评价不同项目在改善生命质量所花费成本的相对大小及公共卫生项目效率的方法[20] DALYs、QALYs和
    HALYs
    成本 – 效用比、增量成本效用比 全面地反映整体健康状况,将发病率、死亡率纳入考虑 生命质量权重系数的确定具有主观性;以当期干预结果预测成年获得的QALYs等具有不确定性[20,51]
    成本 – 效益分析 将公共卫生项目的投入和收益转化为货币进行比较的方法[20] 货币单位 成本 – 效益比、增量成本效益比、净效益、净现值、投资回报率 直观地反映项目成本和效益之间的关系,可以对干预目标差异很大的干预措施进行比较分析[50] 将干预效益货币化的过程具有不确定性,依赖较多假设;不能直接衡量个人从干预中获得的健康益处(如能否行走、是否疼痛等)[50]
    人力资本测算法 假设个人价值等于收入,预测公共卫生项目对未来收入的影响[52] 货币单位 全面、直接地估计了公共卫生项目对生产力的影响 将个人价值等同于收入的做法被认为缺乏伦理学基础;假设劳动力市场是完全平等的;测算人力资本的过程具有不确定性[52-53]
      注:BMI为体质指数,BMI-Z为体质指数Z评分,DALYs为伤残调整寿命年,QALYs为质量调整寿命年,HALYs为健康调整寿命年。
    下载: 导出CSV
  • [1] Horton S, Shekar M, McDonald C, et al. Scaling up nutrition: what will it cost?[R]. Washington: The World Bank, 2010.
    [2] Futures Institute. UN integrated costing tool[EB/OL]. [2020 – 08 – 11]. http://www.who.int/workforcealliance/knowledge/toolkit/10/en/.
    [3] Bhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost[J]. The Lancet, 2013, 382(9890): 452 – 477. doi: 10.1016/S0140-6736(13)60996-4
    [4] Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: a systematic review[J]. Wellcome Open Research, 2020, 5: 62. doi: 10.12688/wellcomeopenres.15781.2
    [5] Waters HR, Penny ME, Creed-Kanashiro HM, et al. The cost-effectiveness of a child nutrition education programme in Peru[J]. Health Policy and Planning, 2006, 21(4): 257 – 264. doi: 10.1093/heapol/czl010
    [6] Ananthapavan J, Sacks G, Brown V, et al. Priority-setting for obesity prevention – the assessing cost-effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study[J]. PLoS One, 2020, 15(6): e0234804. doi: 10.1371/journal.pone.0234804
    [7] Coffield E, Nihiser A, Carlson S, et al. Shape up Somerville′s return on investment: multi-group exposure generates net-benefits in a child obesity intervention[J]. Preventive Medicine Reports, 2019, 16: 100954. doi: 10.1016/j.pmedr.2019.100954
    [8] Brown V, Ananthapavan J, Veerman L, et al. The potential cost-effectiveness and equity impacts of restricting television advertising of unhealthy food and beverages to Australian children[J]. Nutrients, 2018, 10(5): 622. doi: 10.3390/nu10050622
    [9] Adams KP, Lee JA, Piltch E, et al. An introduction to economic analysis of food security and nutrition interventions[J]. Journal of the Academy of Nutrition and Dietetics, 2019, 119(5): 856 – 864. doi: 10.1016/j.jand.2018.11.015
    [10] John J, Wolfenstetter SB, Wenig CM. An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions[J]. Nutrition, 2012, 28(9): 829 – 839. doi: 10.1016/j.nut.2011.11.016
    [11] Drummmond MF, Sculpher MJ, Torrance GW, 等. 卫生保健项目经济学评估方法[M]. 李士雪, 译. 北京: 人民卫生出版社, 2008: 6.
    [12] Hayes A, Lung T, Wen LM, et al. Economic evaluation of “healthy beginnings” an early childhood intervention to prevent obesity[J]. Obesity, 2014, 22(7): 1709 – 1715. doi: 10.1002/oby.20747
    [13] Döring N, Zethraeus N, Tynelius P, et al. Economic evaluation of PRIMROSE – a trial-based analysis of an early childhood interven-tion to prevent obesity[J]. Frontiers in Endocrinology, 2018, 9: 104. doi: 10.3389/fendo.2018.00104
    [14] Anderson YC, Leung W, Grant CC, et al. Economic evaluation of a multi-disciplinary community-based intervention programme for New Zealand children and adolescents with obesity[J]. Obesity Research and Clinical Practice, 2018, 12(3): 293 – 298. doi: 10.1016/j.orcp.2018.04.001
    [15] Cradock AL, Barrett JL, Kenney EL, et al. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood[J]. Preventive Medicine, 2017, 95 Suppl: S17 – S27.
    [16] Reilly KL, Reeves P, Deeming S, et al. Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness[J]. BMC Public Health, 2018, 18(1): 378. doi: 10.1186/s12889-018-5315-y
    [17] Finster MP, Feldman J. Cost-ffectiveness of 2 support models for a healthy school initiative[J]. Journal of School Health, 2020, 90(9): 724 – 730. doi: 10.1111/josh.12931
    [18] Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years[J]. Bulletin of the World Health Organization, 1994, 72(3): 429 – 445.
    [19] Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020[R]. Boston: Harvard School of Public Health, 1996.
    [20] 黄小玲, 张帆, 廖宇航. 公共卫生项目经济学评价方法[M]. 北京: 人民卫生出版社, 2017: 40 – 50.
    [21] Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and survival[J]. The Lancet, 2008, 371(9610): 417 – 440. doi: 10.1016/S0140-6736(07)61693-6
    [22] Shekar M, Eberwein JD, Kakietek J. The costs of stunting in South Asia and the benefits of public investments in nutrition[J]. Maternal and Child Nutrition, 2016, 12(S1): 186 – 195.
    [23] Trenouth L, Colbourn T, Fenn B, et al. The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan[J]. Health Policy and Planning, 2018, 33(6): 743 – 754. doi: 10.1093/heapol/czy045
    [24] Haby MM, Vos T, Carter R, et al. A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project[J]. International Journal of Obesity, 2006, 30(10): 1463 – 1475. doi: 10.1038/sj.ijo.0803469
    [25] Graziose MM, Koch PA, Wang YC, et al. Cost-effectiveness of a nutrition education curriculum intervention in elementary schools[J]. Journal of Nutrition Education and Behavior, 2017, 49(8): 684 – 691. doi: 10.1016/j.jneb.2016.10.006
    [26] Adab P, Barrett T, Bhopal R, et al. The West Midlands ActiVe lifestyle and healthy eating in school children (WAVES) study: a cluster randomised controlled trial testing the clinical effectiveness and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged 6 – 7 years[J]. Health Technology Assessment, 2018, 22(8): 1 – 608. doi: 10.3310/hta22080
    [27] Canaway A, Frew E, Lancashire E, et al. Economic evaluation of a childhood obesity prevention programme for children: results from the WAVES cluster randomised controlled trial conducted in schools[J]. PLoS One, 2019, 14(7): e0219500. doi: 10.1371/journal.pone.0219500
    [28] Li B, Pallan M, Liu WJ, et al. The CHIRPY DRAGON intervention in preventing obesity in Chinese primary-school-aged children: a cluster-randomised controlled trial[J]. PLoS Medicine, 2019, 16(11): e1002971. doi: 10.1371/journal.pmed.1002971
    [29] Hayes A, Tan EJ, Lung T, et al. A new model for evaluation of interventions to prevent obesity in early childhood[J]. Frontiers in Endocrinology, 2019, 10: 132. doi: 10.3389/fendo.2019.00132
    [30] Hoddinott J, Alderman H, Behrman JR, et al. The economic rationale for investing in stunting reduction[J]. Maternal and Child Nutrition, 2013, 9(S2): 69 – 82.
    [31] Hoddinott J. The economics of reducing malnutrition in Sub-Saharan Africa[R]. London: Global Panel on Agriculture and Food Systems for Nutrition, 2016.
    [32] Alderman H, Behrman JR, Puett C. Big numbers about small children: estimating the economic benefits of addressing undernutrition[J]. The World Bank Research Observer, 2017, 32(1): 107 – 125.
    [33] Galasso E, Wagstaff A. The aggregate income losses from childhood stunting and the returns to a nutrition intervention aimed at reducing stunting[J]. Economics and Human Biology, 2019, 34: 225 – 238. doi: 10.1016/j.ehb.2019.01.010
    [34] Xu HQ, Li YP, Du SM, et al. Cost-utility and cost-benefit analyses of school-based obesity prevention program[J]. BMC Public Health, 2020, 20(1): 1608. doi: 10.1186/s12889-020-09718-x
    [35] Wright DR, Kenney EL, Giles CM, et al. Modeling the cost effectiveness of child care policy changes in the U. S.[J]. American Journal of Preventive Medicine, 2015, 49(1): 135 – 147. doi: 10.1016/j.amepre.2015.03.016
    [36] Gortmaker SL, Long MW, Resch SC, et al. Cost effectiveness of childhood obesity interventions: evidence and methods for choices[J]. American Journal of Preventive Medicine, 2015, 49(1): 102 – 111. doi: 10.1016/j.amepre.2015.03.032
    [37] Gortmaker SL, Wang YC, Long MW, et al. Three interventions that reduce childhood obesity are projected to save more than they cost to implement[J]. Health Affairs, 2015, 34(11): 1932 – 1939. doi: 10.1377/hlthaff.2015.0631
    [38] Lier LM, Breuer C, Ferrari N, et al. Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany[J]. Public Health, 2020, 186: 185 – 192. doi: 10.1016/j.puhe.2020.06.012
    [39] Dragojlovic N, Michaux KD, Moumin NA, et al. Economic evaluation of an enhanced homestead food production intervention for undernutrition in women and children in rural Cambodia[J]. Global Food Security, 2020, 24: 100335. doi: 10.1016/j.gfs.2019.100335
    [40] Nugent R, Levin C, Hale J, et al. Economic effects of the double burden of malnutrition[J]. The Lancet, 2020, 395(10218): 156 – 164. doi: 10.1016/S0140-6736(19)32473-0
    [41] Wong B, Radin M. Benefit-cost analysis of a package of early childhood interventions to improve nutrition in Haiti[J]. Journal of Benefit-Cost Analysis, 2019, 10(S1): 154 – 184. doi: 10.1017/bca.2019.1
    [42] 闵维方. 人力资本理论的形成、发展及其现实意义[J]. 北京大学教育评论, 2020, 18(1): 9 – 26.
    [43] 杜育红. 人力资本理论: 演变过程与未来发展[J]. 北京大学教育评论, 2020, 18(1): 90 – 100.
    [44] Wells JC, Sawaya AL, Wibaek R, et al. The double burden of malnutrition: aetiological pathways and consequences for health[J]. The Lancet, 2020, 395(10217): 75 – 88. doi: 10.1016/S0140-6736(19)32472-9
    [45] Heidkamp RA, Piwoz E, Gillespie S, et al. Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the sustainable development goals: an agenda for action[J]. The Lancet, 2021, 397(10282): 1400 – 1418. doi: 10.1016/S0140-6736(21)00568-7
    [46] Hoddinott J, Maluccio JA, Behrman JR, et al. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults[J]. The Lancet, 2008, 371(9610): 411 – 416. doi: 10.1016/S0140-6736(08)60205-6
    [47] Hoddinott JF, Maluccio J, Behrman JR, et al. The consequences of early childhood growth failure over the life course[R]. Washington: International Food Policy Research Institute, 2011.
    [48] Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities[J]. British Medical Bulletin, 2010, 96(1): 5 – 21. doi: 10.1093/bmb/ldq033
    [49] Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the panel on cost-effectiveness in health and medicine[J]. JAMA, 1996, 276(15): 1253 – 1258. doi: 10.1001/jama.1996.03540150055031
    [50] Ginsberg GM. Generalizability of cost-utility analyses across countries and settings[J]. Best Practice and Research Clinical Gastroenterology, 2013, 27(6): 845 – 852. doi: 10.1016/j.bpg.2013.08.017
    [51] 徐海泉. 儿童肥胖干预措施的经济学评估研究进展[J]. 中国慢性病预防与控制, 2012, 20(1): 93 – 95. doi: 10.16386/j.cjpccd.issn.1004-6194.2012.01.038
    [52] Centers for Disease Control and Prevention. Five-part webcast on economic evaluation[EB/OL]. [2021 – 12 – 07]. https://www.cdc.gov/dhdsp/evaluation_resources/economic_evaluation/index.htm.
    [53] 孟丽苹, 马冠生. 儿童营养改善项目的经济学评价[J]. 中国慢性病预防与控制, 2012, 20(6): 720 – 723. doi: 10.16386/j.cjpccd.issn.1004-6194.2012.06.016
    [54] Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement[J]. BMC Medicine, 2013, 11(1): 80. doi: 10.1186/1741-7015-11-80
  • 加载中
表(1)
计量
  • 文章访问数:  12
  • HTML全文浏览量:  4
  • PDF下载量:  1
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-09-01
  • 网络出版日期:  2022-08-31

目录

    /

    返回文章
    返回