Best Buy in Public Health or Luxury Expense?

Yap, Ava; Cheung, Maija; Muzira, Arlene; Healy, James M.; Kakembo, Nasser; Kisa, Phyllis; Cunningham, David A.; Youngson, George; Sekabira, John; Yaesoubi, Reza; Ozgediz, Doruk

doi:10.1097/sla.0000000000003263

Cited by 16 publications

(15 citation statements)

References 26 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Investing in surgery is highly cost-effective as analyses conducted at two KidsOR sites show. In Uganda where essentially emergent, life-saving cases were served, the cost to save a year of healthy life was US$6.4,36 while in Nigeria, where a pre-existing children’s surgical service was already in place and focused more on elective cases, the cost was $77 37. Likewise, the LCoGS pointed out the monetary benefits of enabling access to safe surgery as an investment of $350 billion until 2030 would avoid an estimated loss of $12.3 trillion in lost productivity and healthcare expenses 1…”

Section: Building Capacity For Paediatric Surgery: a Health Systems S...mentioning

confidence: 99%

Providing paediatric surgery in low-resource countries

Bryce

Fedatto

Cunningham

2023

bmjpo

Self Cite

View full text Add to dashboard Cite

Successful health systems comprise good outcomes, accessibility and availability. Surgery is the service that cuts across many treatment scenarios, yet in low- and middle-income countries 90% of people cannot access it. Estimates using most recent population data suggest that 1.75 billion children lack access to surgical care. Additionally, 30% of the global burden of disease is treatable with surgery, yet in LMICs as much as 87% of the surgical need remains unmet. Paediatric surgical services are not at the level they need to be, highlighting an increasing surgical burden on children’s health globally with a human cost of morbidity and mortality. Achieving Universal Health Coverage and the Sustainable Development Goals will fail if surgical systems are not strengthened in low resource settings.In 2018, global health charity Kids Operating Room was founded with a goal of ensuring every child has access to the surgery they need. The charity has a four-pillar approach to its work: provision of infrastructure and equipment, paediatric surgical workforce training, database development and research capacity strengthening, and advocating on behalf of children denied access to safe surgery. To ensure that paediatric surgical interventions produce real impact on service delivery, contextual understanding and needs assessment are key. The building of paediatric surgical capacity should align to countries’ priorities and wishes. Investing in local health workforce is essential to delivering quality services, supporting resilient health systems and provides integrated, people-centred health services. A competent surgical information system gives the local surgical workforce the tools needed to action evidence-driven decisions.Strengthening surgical services in a manner aligned to the WHO’s fundamental health system building blocks, allows for sustainable and long-lasting change. Confronting bottlenecks that exist in surgical services and establishing multi-faceted development, will allow global, national and local surgical targets to be met.

show abstract

Section: Building Capacity For Paediatric Surgery: a Health Systems S...mentioning

confidence: 99%

Providing paediatric surgery in low-resource countries

Bryce

Fedatto

Cunningham

2023

bmjpo

Self Cite

View full text Add to dashboard Cite

show abstract

“…This intervention was highly cost-effective in the first OR installation in Uganda, but the results have not been validated or replicated elsewhere. (12) Here we report a CEA of two operating room installations adding to a pre-existing pediatric surgical service in Nigeria.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

“…(Table 2) Ranges are informed by prior studies or +/-0•2 when unavailable, based on the previous methodology. (12,20) ICER uncertainty intervals were obtained by bootstrapping over 100 samples. Results from the probabilistic sensitivity analysis were depicted in cost-effectiveness planes.…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

“…This study's cost-effectiveness is higher than that of another CEA we conducted for an OR installation in Uganda, at $37•35 per DALY averted. (12) This difference can be attributed to several site characteristics. First, Nigeria's lower life expectancy (54 years) compared to Uganda's (63 years) led to a lower number of years saved per surgery.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of a Pediatric Operating Room Installation in Sub-Saharan Africa

Yap

Halid

Ukwu

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

The unmet need for pediatric surgery incurs enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of economic impact data on improving pediatric surgical infrastructure in SSA precludes informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and maintaining a pediatric operating room in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of two dedicated pediatric operating rooms (ORs), which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital’s operative registry and prior literature. A societal perspective included costs incurred by the hospital system, charity, and patients’ families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation were presented from charity and societal perspectives. One-way and probabilistic sensitivity analyses were performed. We found that the installation and maintenance of two pediatric operating rooms averted 1145 DALYs and cost $155,509 annually. Annualized OR installation cost was $87,728 (56% of the overall cost). The ICER of the OR installation was $152 per DALY averted (95% uncertainty interval [UI] 147-156) from the societal perspective, and $77 per DALY averted (95% UI 75-81) from the charity perspective. These ICERs were well under the cost-effectiveness threshold of the country’s half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional pediatric operating rooms in SSA with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children’s global surgical infrastructure as an economically sound intervention.

show abstract

“…Cost‐effectiveness analysis can be extremely useful in informing changes in health‐care policy in resource‐limited settings [52]. Its main advocacy role is to inform policy makers that surgical care is a good financial investment, i.e., that surgical care is at least as cost‐effective as its non‐surgical counterparts, and that it is a value‐added proposition to any society.…”

Section: Developing Metrics In Children’s Surgerymentioning

confidence: 99%

Developing Metrics to Define Progress in Children’s Surgery

Poenaru

Seyi‐Olajide

2018

World j. surg.

View full text Add to dashboard Cite

There is a need for relevant, valid, and practical metrics to better quantify both need and progress in global pediatric surgery and for monitoring systems performance. There are several existing surgical metrics in use, including disability‐adjusted life years (DALYs), surgical backlog, effective coverage, cost‐effectiveness, and the Lancet Commission on Global Surgery indicators. Most of these have, however, not been yet applied to children’s surgery, leaving therefore significant data gaps in the burden of disease, infrastructure, human resources, and quality of care assessments in the specialty. This chapter reviews existing global surgical metrics, identifies settings where these have been already applied to children’s surgery, and highlights opportunities for further inquiry in filling the knowledge gaps. Directing focused, intentional knowledge translation efforts in the identified areas of deficiency will foster the maturation of global pediatric surgery into a solid academic discipline able to contribute directly to the cause of improving the lives of children around the world.

show abstract

Best Buy in Public Health or Luxury Expense?

Cited by 16 publications

References 26 publications

Providing paediatric surgery in low-resource countries

Providing paediatric surgery in low-resource countries

Cost-Effectiveness of a Pediatric Operating Room Installation in Sub-Saharan Africa

Developing Metrics to Define Progress in Children’s Surgery

Contact Info

Product

Resources

About