Economic evaluations of interventions for the treatment and management of non-communicable diseases in humanitarian contexts: A scoping review

Humanitarian crises profoundly disrupt health systems and limit access to healthcare. People with non-communicable diseases (NCDs) are among the most vulnerable groups affected. As humanitarian interventions often focus on acute health needs, NCDs are often overlooked in financing and service delivery. In such contexts, efficient strategies are crucial for maximising health benefits and ensuring equitable service delivery. Health economic evaluations provide decision-makers with evidence on optimal resource allocation. Given the high burden of NCDs and the uncertainty about the effectiveness of their management in such contexts, this review aims to map available evidence from studies that utilised health economic approaches to assess NCD programmes implemented in humanitarian contexts. Systematic searches were conducted across seven electronic databases: Ovid Medline, Global Health, Embase, Scopus, Web of Science, CAB, and EconLit, alongside grey literature. Eligible studies were full economic evaluations (cost-effectiveness, cost-utility, and cost-benefit analyses) of NCD interventions in humanitarian contexts. Of the 6911 deduplicated records screened, seven studies met the inclusion criteria; a structured Excel sheet charted key study characteristics. The included evidence comprised four studies from conflict-affected lower-middle-income countries, and three from natural disaster settings in high-income countries. No studies from low-income countries met the inclusion criteria. NCDs addressed included mental health (n = 4), asthma (n = 2), and congestive heart failure (n = 1). One study addressed broader NCD-related public health interventions, including cancer screening and management, and incorporated diabetes into an NCD burden model without cost-effectiveness analysis. Methodological approaches varied, including simulation/microsimulation (n = 3), trial-based economic evaluations (n = 3), and a Markov model (n = 1). The review highlights limited and fragmented evidence to support decision-making and long-term planning, particularly in low-income settings. Further research is needed to understand how health economic evidence for NCDs can be generated, interpreted and used within humanitarian decision-making systems, and to support allocation of scarce resources for people living with NCDs during crises.