Cost-effectiveness of neonatal surgery for congenital anomalies in low-income and middle-income countries: a systematic review protocol

Abstract

IntroductionCongenital anomalies are the fifth leading cause of death in children under 5 years old globally (591 000 deaths reported in 2016). Over 95% of deaths occur in low-income and middle-income countries (LMICs). It is estimated that two-thirds of the congenital anomaly health burden could be averted through surgical intervention and that such interventions can be cost-effective. This systematic review aims to evaluate current evidence regarding the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs.Methods and analysisA systematic literature review will be conducted in PubMed, MEDLINE, Embase, Cochrane Library, Scielo, Google Scholar, African Journals OnLine and Regional WHO’s African Index Medicus databases for articles on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs. The following search strings will be used: (1) congenital anomalies; (2) LMICs; and (3) cost-effectiveness of surgical interventions. Articles will be uploaded to Covidence software, duplicates removed and the remaining articles screened by two independent reviewers. Cost information for interventions or procedures will be extracted by country and condition. Outcome measurements by reported unit and cost-effectiveness ratios will be extracted. Methodological quality of each article will be assessed using the Drummond checklist for economic evaluations. The Agency for Healthcare Research and Quality’s Effective Health Care Program guidance will be followed to assess the grade of the studies.Ethics and disseminationNo ethical approval is required for conducting the systematic review. There will be no direct collection of data from individuals. The finalised article will be published in a scientific journal for dissemination. The protocol has been registered with PROSPERO (International Prospective Register of Systematic Reviews).ConclusionCongenital anomalies form a large component of the global health burden that is amenable to surgical intervention. This study will systematically review the current literature on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs.PROSPERO registration numberCRD42020172971.

Neonatal Surgical Morbidity and Mortality at a Single Tertiary Center in a Low- and Middle-Income Country: A Retrospective Study of Clinical Outcomes

“…The actual data regarding neonatal surgical patient load in Bangladesh is not available, but this burden is increasing and contributing significantly to the causal list of neonatal mortality. Optimum surgical care could avoid at least twothirds of this mortality (5,(7)(8)(9)(10). United Nations sustainable development goal (SDG-3) targets to end preventable neonatal death by the year 2030 (11).…”

“…The data available are only based on inpatient admitted babies. However, a large proportion of the neonates in LMICs have no access to surgical care, which further magnifies the outcome differences ( 5 , 9 ).…”

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“…This information is revealing, implying that considerable proportion of Hospital-visiting relatives/general public were oblivious to successes being recorded, although some infant surgical procedures may have been effectively carried out. This lack of knowledge is concerning as babies born with surgically correctible congenital anomalies are not be brought to the health facilities but left in the communities to die obscuring the true burden of the disease as has been reported in other low and middle-income countries [46] . However, we also observed that the majority of the respondents (86.0%) were aware of the possibility of successful surgery in the old and also, the majority knew someone who has had successful surgery in old age.…”