Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis

Chao, Tiffany E.; Sharma, Ketan; Mandigo, Morgan; Hagander, Lars; Resch, Stephen; Weiser, Thomas; Meara, John G.

doi:10.1016/s2214-109x(14)70213-x

Cited by 298 publications

(239 citation statements)

References 47 publications

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“…Many of these injuries are surgically treatable, yet a widespread perception persists that surgery is inordinately expensive presents a major barrier to & Erik J. Kramer erik.kramer@yale.edu the implementation of surgery in the global health agenda [2,3]. However, recent studies have demonstrated strong evidence that surgery, including orthopaedic intervention, is often as cost-effective as many non-surgical interventions in widespread use in LMICs [4][5][6][7]. Musculoskeletal injuries contributed heavily to this growing burden as a result of the proliferation of access to motorized transportation and corresponding increases in morbidity and mortality in LMICs [8,9].…”

Section: Introductionmentioning

confidence: 99%

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

et al. 2016

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Background Femoral shaft fractures are one of the most common injuries seen by surgeons in low-and middleincome countries (LMICs). Surgical repair in LMICs is often dismissed as not being cost-effective or unsafe, though little evidence exists to support this notion. Therefore, the goal of this study is to determine the cost of intramedullary nailing of femoral shaft fractures in Tanzania. Methods We used micro-costing methods to estimate the fixed and variable costs of intramedullary nailing of femoral shaft fractures. Variable costs assessed included medical personnel costs, ward personnel costs, implants, medications, and single-use supplies. Fixed costs included costs for surgical instruments and administrative and ancillary staff. Results 46 adult femoral shaft fracture patients admitted to Muhimbili Orthopaedic Institute between June and September 2014 were enrolled and treated with intramedullary fixation. The total cost per patient was $530

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Section: Introductionmentioning

confidence: 99%

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

et al. 2016

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“…Surgically managed conditions are commonly not perceived as cost-effective, while costeffective health measures, such as vaccination, often take precedence in global health campaigns. 13 Although the economic burden of hydrocephalus management is great, emerging evidence suggests that the neurosurgical management of hydrocephalus is costeffective in the developing world. In a Ugandan study, the cost-effectiveness ratio for hydrocephalus surgery was $108.74 US dollars per disability-adjusted life-year (DALY)-comparable to WHO vaccination campaigns ($51.86-$220.39 per DALY).…”

Section: Economic Considerationsmentioning

confidence: 99%

“…In a Ugandan study, the cost-effectiveness ratio for hydrocephalus surgery was $108.74 US dollars per disability-adjusted life-year (DALY)-comparable to WHO vaccination campaigns ($51.86-$220.39 per DALY). 13 Furthermore, although the up-front cost of treating all incident cases of hydrocephalus in sub-Saharan Africa in 1 year would approach $190 million, it would confer an estimated lifetime economic benefit of $1.4 billion. 69 Similar results have been demonstrated in cost-effectiveness analyses in Haiti 76 and Guatemala.…”

Section: Economic Considerationsmentioning

confidence: 99%

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

Muir

Wang

Warf

2016

FOC

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OBJECTIVE Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Significant health disparities exist for the treatment of hydrocephalus in developing nations due to a combination of medical, environmental, and socioeconomic factors. This review aims to provide the international neurosurgery community with an overview of the current challenges and future directions of neurosurgical care for children with hydrocephalus in low-income countries. METHODS The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. RESULTS Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. CONCLUSIONS Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

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“…Surgical care in low‐ and middle‐income countries (LMICs) has suffered from insufficient prioritization, especially in rural settings1, 2, 3, 4. Low‐income countries struggle with an insufficient surgical workforce; the surgical specialist workforce density is 0·7 per 100 000 population5, far below the recommendation1 of 20 per 100 000 population.…”

Section: Introductionmentioning

confidence: 99%

“…Because of a history of patients with conditions that need surgical intervention being referred to higher‐level hospitals and the perception that higher‐level hospitals should provide surgery, surgical care is often viewed as expensive compared with the medical management of other diseases2 3, 7. However, a systematic review3 of the cost‐effectiveness of surgical care showed that most essential surgical interventions, such as general surgery, caesarean sections and orthopaedic surgery, are cost‐effective in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

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Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis

Cited by 298 publications

References 47 publications

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

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