A Square Peg in a Round Hole? Challenges with DALY‐based “Burden of Disease” Calculations in Surgery and a Call for Alternative Metrics

Gosselin, Richard A.; Ozgediz, Doruk; Poenaru, Dan

doi:10.1007/s00268-013-2182-7

Cited by 32 publications

(27 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One is that prevalence-based estimates of disease are not ideally suited to encapsulate the complexity of surgical need. 29 A simple example is circumcision – shown to reduce HIV transmission by as much as 60% – which is not performed for a diagnosis of disease at all, but rather to prevent the occurrence of disease. 30 Another example is bariatric surgery – effective in the treatment of obesity – which is performed to treat a highly prevalent epidemic in HICs that is not included within the GHE taxonomy.…”

Section: Discussionmentioning

confidence: 99%

Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate

Rose

Weiser

Hider

et al. 2015

The Lancet Global Health

336

247

View full text Add to dashboard Cite

Background Surgery is a foundational component of health care systems. However, previous efforts to integrate surgical services into global health initiatives do not reflect the scope of surgical need and many health systems do not provide essential interventions. We estimate the minimum global volume of surgical need to address prevalent diseases in 21 epidemiological regions from the Global Burden of Disease Study 2010 (GBD). Methods Prevalence data were obtained from GBD 2010 and organized into 119 disease states according to the World Health Organization’s Global Health Estimate (GHE). These data, representing 187 countries, were then apportioned to the 21 GBD epidemiological regions. Using previously defined values for the incident need for surgery for each of the 119 GHE disease states, we calculate minimum global need for surgery based on the prevalence of each condition in each region. Results We estimate that at least 321·5 million surgical procedures would be needed to address the burden of disease for a global population of 6.9 billion in 2010. Minimum rates of surgical need vary across regions, ranging from 3,383 operations per 100,000 in Central Latin America to 6,495 operations per 100,000 in Western Sub-Saharan Africa. Global surgical need also varied across sub-categories of disease, ranging from 131,412 procedures for Nutritional Deficiencies to 45.8 million procedures in Unintentional Injuries. Conclusions The estimated need for surgical procedures worldwide is large and addresses a broad spectrum of disease states. Surgical need varies between regions of the world according to disease prevalence and many countries do not meet the basic needs of their populations. These estimates may be useful for policy makers, funders, and ministries of health as they consider how to incorporate surgical capacity into health systems.

show abstract

Section: Discussionmentioning

confidence: 99%

Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate

Rose

Weiser

Hider

et al. 2015

The Lancet Global Health

336

247

View full text Add to dashboard Cite

show abstract

“…For each patient, the DALY value represents the burden of an untreated condition. This value has been subsequently adjusted for likelihood of permanent disability and likelihood of treatment success as described in the literature by McCord and Chowdry and modified by Gosselin et al [12–16] and represents the DALYs averted with surgery (Table 3). To err on side of overestimating cost per DALY averted, we chose conservative weights for disability, likelihood of permanent disability, and effectiveness of treatment.…”

Section: Methodsmentioning

confidence: 99%

Helping Hands: A Cost-Effectiveness Study of a Humanitarian Hand Surgery Mission

Tadisina

Chopra

Tangredi

et al. 2014

Plastic Surgery International

View full text Add to dashboard Cite

Purpose. Congenital anomalies and injuries of the hand are often undertreated in low-middle income countries (LMICs). Humanitarian missions to LMICs are commonplace, but few exclusively hand surgery missions have been reported and none have attempted to demonstrate their cost-effectiveness. We present the first study evaluating the cost-effectiveness of a humanitarian hand surgery mission to Honduras as a method of reducing the global burden of surgically treatable disease. Methods. Data were collected from a hand surgery mission to San Pedro Sula, Honduras. Costs were estimated for local and volunteer services. The total burden of disease averted from patients receiving surgical reconstruction was derived using the previously described disability-adjusted life years (DALYs) system. Results. After adjusting for likelihood of disability associated with the diagnosis and likelihood of the surgery's success, DALYs averted totaled 104.6. The total cost for the mission was $45,779 (USD). The cost per DALY averted was calculated to be $437.80 (USD), which is significantly below the accepted threshold of two times the per capita gross national income of Honduras. Conclusions. This hand surgery humanitarian mission trip to Honduras was found to be cost-effective. This model and analysis should help in guiding healthcare professionals to organize future plastic surgery humanitarian missions.

show abstract

“…The GBD 2004 study, 2 which focused mainly on injuries, was also criticized as the disability weights for several injuries appeared illogical 10 . Such inconsistencies led to the appropriateness and usefulness of many disability weights being questioned 10 .…”

Section: Introductionmentioning

confidence: 99%

“…Such inconsistencies led to the appropriateness and usefulness of many disability weights being questioned 10 . The GBD 2010 study 3 tried to address these criticisms using multinational community and web-based surveys.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Estimating the effectiveness of a hospital’s interventions in India: impact of the choice of disability weights

Chatterjee

Gosselin

2015

Bull. World Health Organ.

View full text Add to dashboard Cite

ObjectiveTo calculate the effect of using two different sets of disability weights for estimates of disability-adjusted life-years (DALYs) averted by interventions delivered in one hospital in India.MethodsDALYs averted by surgical and non-surgical interventions were estimated for 3445 patients who were admitted to a 106-bed private hospital in a semi-urban area of northern India in 2012–2013. Disability weights were taken from global burden of disease (GBD) studies. We used the GBD 1990 disability weights and then repeated all of our calculations using the corresponding GBD 2010 weights. DALYs averted were estimated for surgical and non-surgical interventions using disability weight, risk of death and/or disability, and effectiveness of treatment.FindingsThe disability weights assigned in the GBD 1990 study to the sequelae of conditions such as cataract, cancer and injuries were substantially different to those assigned in the GBD 2010 study. These differences in weights led to large differences in estimates of DALYs averted. For all surgical interventions delivered to this patient cohort, 11 517 DALYs were averted if we used the GDB 1990 weights and 9401 DALYs were averted if we used the GDB 2010 disability weights. For non-surgical interventions 5168 DALYs were averted using the GDB 1990 disability weights and 5537 DALYS were averted using the GDB 2010 disability weights.ConclusionEstimates of the effectiveness of hospital interventions depend upon the disability weighting used. Researchers and resource allocators need to be very cautious when comparing results from studies that have used different sets of disability weights.

show abstract

A Square Peg in a Round Hole? Challenges with DALY‐based “Burden of Disease” Calculations in Surgery and a Call for Alternative Metrics

Abstract: These approaches warrant further exploration in LMICs and these debates require active engagement by surgical providers and advocates globally.

Cited by 32 publications

References 32 publications

Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate

Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate

Helping Hands: A Cost-Effectiveness Study of a Humanitarian Hand Surgery Mission

Estimating the effectiveness of a hospital’s interventions in India: impact of the choice of disability weights

Contact Info

Product

Resources

About