In a bid to assess the economic viability of gender-transformative interventions aimed at preventing unintended pregnancies and promoting sexual health among adolescents, a new systematic review has synthesized the best-available evidence from numerous studies. This investigation delves into economic evaluations reported under stringent methodological standards to uncover gaps and highlight the efficacy of these interventions. The findings emphasize the importance of market access in making these interventions widely available, particularly in resource-limited settings, to maximize their impact.
Methodological Approach and Data Collection
The review adhered to the PRISMA guidelines and involved a meticulous search across several bibliographic databases, including PubMed, Cochrane, and SCOPUS. The selection criteria focused on articles published between January 1, 1990, and December 31, 2021, encompassing adolescents aged 10-19. Two independent reviewers conducted both title and full-text screenings to ensure rigorous selection. Data extraction and quality assessment were performed by one reviewer and verified by another, utilizing the CHEERS statement and CHEC checklist for consistency.
Key Findings and Quality of Evidence
The comprehensive review included 22 studies, with 16 categorized as full economic evaluations and six as partial. The majority of these studies demonstrated moderate to high quality. Notably, the most frequently reported outcomes were the incremental cost-effectiveness ratio, costs per averted sexually transmitted infection (STI), quality-adjusted life years (QALYs) saved per averted infection, and costs per averted pregnancy. These outcomes are critical for understanding the cost-effectiveness and potential market access of these interventions.
The findings revealed that most gender-transformative interventions were either cost-effective or cost-saving, underscoring their economic viability. However, a significant gap was identified in the availability of economic evaluations for many existing interventions, particularly those originating from low- and middle-income countries (LMICs). This gap highlights the need for targeted economic evaluation studies to ensure these interventions can be effectively scaled and accessed in diverse markets.
Concrete Inferences
Significant Insights:
– The majority of studies indicate that gender-transformative interventions are economically viable, offering cost-effective solutions for adolescent sexual health.
– There is a notable scarcity of economic evaluations from LMICs, suggesting a need for more inclusive research to facilitate broader market access.
– Methodological quality is generally high, but the development of specific guidelines for economic evaluations of gender-transformative interventions is necessary.
In conclusion, while the economic evaluations provide strong evidence for the cost-effectiveness of gender-transformative interventions, there is a pressing need to expand research into diverse geographic and economic contexts. This will ensure that such interventions can achieve widespread market access and impact, particularly in regions where adolescent sexual health needs are most critical.
Original Article:
Soc Sci Med. 2024 Jul 14;355:117130. doi: 10.1016/j.socscimed.2024.117130. Online ahead of print.
ABSTRACT
AIMS: We synthesised the best-available evidence on economic evaluations of gender-transformative interventions that prevent unintended pregnancy and promote sexual-health in adolescents. We also assessed the methodological quality of the economic-evaluation studies and identified gaps in the economic-evaluation evidence.
DESIGN: A systematic review (SR) of economic evaluations reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2020.
DATA SOURCES: We searched the following bibliographic databases for economic evaluations that met our selection criteria; PubMed, Cochrane, National Health Service EE database, SCOPUS, CINHAL, Web of Science and Paediatric EE Database. We also conducted a grey literature search. We included articles published from January 1, 1990 to December 31, 2021, in English, including adolescents aged 10-19. Two independent reviewers conducted the title and full-text screening.
DATA EXTRACTION AND SYNTHESIS: One reviewer conducted data extraction and quality assessment, which a second reviewer checked. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and Consensus on Health Economic Criteria (CHEC) checklist to measure the reporting and methodological quality. Synthesis was done narratively and using summary tables.
RESULTS: Twenty-two studies were included, with 16 full and six partial economic evaluations. The quality of studies was moderate to high for most. The most reported outcomes were incremental cost-effectiveness ratio, costs per averted sexually transmitted infection, quality-adjusted life years saved per averted infection and costs per averted pregnancy. Most studies were cost-effective or cost-saving.
CONCLUSIONS: Most of the economic evaluations are cost-effective. There is a scarcity of available economic evaluations for most existing gender-transformative interventions, with most included studies originating from high-income countries (HICs). There is a need to develop guidance specific to economic evaluations of gender-transformative interventions.
PMID:39042985 | DOI:10.1016/j.socscimed.2024.117130
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