Cost‐Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist

Shrime, Mark G.; Alkire, Blake C; Grimes, Caris; Chao, Tiffany E.; Poenaru, Dan; Verguet, Stéphane

doi:10.1007/s00268-017-3875-0

Cited by 48 publications

(64 citation statements)

References 64 publications

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“…A decision tree base template was constructed to compare life trajectories that pediatric surgical patients take with or without surgical intervention, based on previously suggested methods. 7 To emulate realistic patient outcomes, the tree identifies a range of post-treatment scenarios, including immediate death and discharge, as well as long-term mortality, disability, and successful cure. The incremental deltas between OR costs and disease burden averted by surgical treatment and the counterfactual is the difference between the two branches at the decision node (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Cost effectiveness analysis (CEA) as an economic tool has been recently popularized by the Disease Control Priorities series 6 and adopted by the global surgery community. 7 In this context, CEA can help guide otherwise difficult decisions to channel limited resources toward the most efficient avenues. To date, there has been no cost-effectiveness study to quantify the cost proportional to health utility gained from a pediatric OR.…”

Section: Introductionmentioning

confidence: 99%

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A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

Yap

Muzira

Cheung

et al. 2018

Surgery

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

Yap

Muzira

Cheung

et al. 2018

Surgery

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“…The literature of cost–effectiveness research, 11 and, more recently, of value-based health care 12 has defined value as: Although theoretically attractive, operationalizing this ratio is difficult when there are multiple inputs and outputs.…”

Section: Methodsmentioning

confidence: 99%

“…Cost‒effectiveness analysis looks only at costs and health benefits. The first policy costs US$ 20 per disability-adjusted life-years averted, while the second policy carries an incremental cost‒effectiveness ratio 11 of US$ 900 disability-adjusted life-years averted. Decision-making is straightforward: if these ratios are less than society’s willingness to pay, the policy is deemed cost–effective.…”

Section: Methodsmentioning

confidence: 99%

Health-system-adapted data envelopment analysis for decision-making in universal health coverage

Shrime

Mukhopadhyay

Alkire

2018

Bull. World Health Organ.

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ObjectiveTo develop and test a method that allows an objective assessment of the value of any health policy in multiple domains.MethodsWe developed a method to assist decision-makers with constrained resources and insufficient knowledge about a society’s preferences to choose between policies with unequal, and at times opposing, effects on multiple outcomes. Our method extends standard data envelopment analysis to address the realities of health policy, such as multiple and adverse outcomes and a lack of information about the population’s preferences over those outcomes. We made four modifications to the standard analysis: (i) treating the policy itself as the object of analysis, (ii) allowing the method to produce a rank-ordering of policies; (iii) allowing any outcome to serve as both an output and input; and (iv) allowing variable return to scale. We tested the method against three previously published analyses of health policies in low-income settings.ResultsWhen applied to previous analyses, our new method performed better than traditional cost–effectiveness analysis and standard data envelopment analysis. The adapted analysis could identify the most efficient policy interventions from among any set of evaluated policies and was able to provide a rank ordering of all interventions.ConclusionHealth-system-adapted data envelopment analysis allows any quantifiable attribute or determinant of health to be included in a calculation. It is easy to perform and, in the absence of evidence about a society’s preferences among multiple policy outcomes, can provide a comprehensive method for health-policy decision-making in the era of sustainable development.

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“…Saxton et al 2 highlight these issues, recommending that further research solidify how DALYs and disability weights are used to evaluate economic impact, accounting for the issues caused by surgical procedures' complexity and the difficulty of identifying surgical components of multidisciplinary care. Shrime et al 19 likewise notes the wide variation in how DALYs are calculated and includes an equation to obtain an accurate estimate of DALYs averted, emphasising the importance of including disability weight, risk of death, probability of successful treatment and risk of permanent disability estimates in the calculation.…”

Section: How Are Researchers Measuring the Potential Economic Benefitmentioning

confidence: 99%

Methods for estimating economic benefits of surgical interventions in low-income and middle-income countries: a scoping review

et al. 2020

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ObjectivesStudies indicate that many types of surgical care are cost-effective compared with other health interventions in low-income and middle-income countries (LMICs). However, global health investments to support these interventions remain limited. This study undertakes a scoping review of research on the economic impact of surgical interventions in LMICs to determine the methodologies used in measuring economic benefits.DesignThe Arksey and O’Malley methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist were used to review the data systematically. Online databases were used to identify papers published between 2005 and 2020, from which we selected 19 publications that quantitatively examined the economic benefits of surgical interventions in LMICs.ResultsMajority of publications (79%) reported the use of disability-adjusted life-years (DALYs) to assess economic impact. In comparison, 21% used other measures, such as the value of statistical life or cost-effectiveness ratios, or no measure at all. 31% were systematic or retrospective reviews of the literature on surgical procedures in LMICs, while 69% either directly assessed economic impact in a specific area or evaluated the need for surgical procedures in LMICs. All studies reviewed related to the economic impact of surgical procedures in LMICs, with most about paediatric surgical procedures or a specific surgical specialty.ConclusionTo make informed policy decisions regarding global health investments, the economic impact must be accurately measured. Researchers employ a range of techniques to quantify the economic benefit of surgeries in LMICs, which limits understanding of overall economic value. We conclude that the literature would benefit from a careful selection of methods, incorporating age and disability weights based on the Global Burden of Disease weights, and converting DALYs to dollars using the value of statistical life approach and the human capital approach, reporting both estimates.

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Cost‐Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist

Abstract: Cost-effectiveness analyses, when done rigorously, can be very useful for the development of efficient surgical systems in LMICs. This review highlights the common pitfalls in these analyses and methods to avoid these pitfalls.

Cited by 48 publications

References 64 publications

A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

Health-system-adapted data envelopment analysis for decision-making in universal health coverage

Methods for estimating economic benefits of surgical interventions in low-income and middle-income countries: a scoping review

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