Abstract
Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.
Highlights
Cardiovascular diseases (CVDs) and diabetes are the noncommunicable diseases (NCDs) that contribute the most to the increasing burden of disease and add to the challenges of health systems in low- and middle-income countries (LMICs) [1]
Our interest was in population or mass screening strategies that aimed at early detection of CVD and diabetes
The usage of SMARThealth mobile technology in Indonesia to screen and manage cardiovascular diseases was cost-effective compared to no SMARThealth gaining USD429 per disability-adjusted life years (DALYs) averted [34]
Summary
Cardiovascular diseases (CVDs) and diabetes are the noncommunicable diseases (NCDs) that contribute the most to the increasing burden of disease and add to the challenges of health systems in low- and middle-income countries (LMICs) [1]. The most effective way of managing this onslaught of NCDs is pairing curative services with strategically planned and tailored preventive interventions, such as screening, especially in the context of attaining and sustaining Universal Health Coverage (UHC) [4–6]. Economic evaluations are performed for “budget burners” or high-cost interventions such as cancer drugs or clinical treatments for NCDs [13]. These evaluations are crucial for preventive interventions, mainly when adopted for whole populations [14, 15]. This systematic review aims to consolidate and synthesize evidence of the costs and benefits of screening interventions for diabetes and CVDs in LMICs. our objectives are to review the economic evaluations of screening programs for early detection of CVD and diabetes; and identify the gaps in evidence of the costeffectiveness of screening programs from LMICs to provide direction for future research
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