Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

Saxton, Anthony T.; Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A.; Farmer, Diana L.; Smith, Emily R.; Rice, Henry E.

doi:10.1371/journal.pone.0165480

Cited by 76 publications

(84 citation statements)

References 103 publications

(41 reference statements)

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“… 15 , 16 , 17 Many areas of surgical care for children are cost-effective and in appropriate settings can provide financial protection against medical impoverishment to families in need. 18 , 19 …”

Section: Introductionmentioning

confidence: 99%

Prevalence of Pediatric Surgical Conditions Across Somaliland

et al. 2019

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Key Points Question What is the prevalence of pediatric surgical conditions in Somaliland? Findings In this cross-sectional study that included 1503 children in Somaliland, the prevalence of pediatric surgical conditions was 12.2%. Only 23.7% of surgical conditions had been corrected at the time of this study. Meaning A scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in low- and middle-income countries is warranted.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Pediatric Surgical Conditions Across Somaliland

et al. 2019

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“…There are also concerns about cost-effectiveness and long-term impact. 7,33 Current results, however, suggest a positive impact of such collaborations. A recent meta-analysis demonstrated that many surgical interventions, including surgical treatment of hydrocephalus ($108.74 per disability-adjusted life year), are, in fact, cost-effective in resource-poor countries.…”

Section: Difficulties and Limitations Of The Different Modelsmentioning

confidence: 89%

Global neurosurgery: models for international surgical education and collaboration at one university

Almeida

Velásquez

Karekezi

et al. 2018

Neurosurgical Focus

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OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

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“…Our utilitarian analysis supports the conclusions of others, who have stated, based on cost-effectiveness, that addressing the global deficit of surgical care is a "moral imperative", 8 and have named congenital heart surgery, in particular, as one of the "essential children's surgical procedures". 21 The most recent recommendation of the Disease Control Priorities project, 24 although less specific, suggests that "all countries can begin to consider building capacity for the treatment of CHD".…”

Section: Cost-effectiveness and Humanitarian Medicinementioning

confidence: 99%

Ethics in humanitarian efforts: when should resources be allocated to paediatric heart surgery?

Fenton¹,

Cardarelli²,

Molloy³

et al. 2018

Cardiol Young

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BackgroundIn countries with ample resources, no debate exists as to whether heart surgery should be provided. However, where funding is limited, what responsibility exists to care for children with congenital heart defects? If children have a “right” to surgical treatment, to whom is the “duty” to provide it assigned? These questions are subjected to ethical analysis.MethodsExamination is initially based on the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Consideration of beneficence and justice is expanded using a consequentialist approach.ResultsSocial structures, including governments, exist to foster the common good. Society, whether by means of government funding or otherwise, has the responsibility, according to the means available, to assure health care for all based on the principles of beneficence, non-maleficence, and justice. In wealthy countries, adequate resources exist to fund appropriate treatment; hence it should be provided to all based on distributive justice. In resource-limited countries, however, decisions regarding provision of care for expensive or complex health problems must be made with consideration for broader effects on the general public. Preliminary data from cost-effectiveness analysis indicate that many surgical interventions, including cardiac surgery, may be resource-efficient. Given that information, utilitarian ethical analysis supports dedication of resources to congenital heart surgery in many low-income countries. In the poorest countries, where access to drinking water and basic nutrition is problematic, it will often be more appropriate to focus on these issues first.ConclusionEthical analysis supports dedication of resources to congenital heart surgery in all but the poorest countries.

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Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

Cited by 76 publications

References 103 publications

Prevalence of Pediatric Surgical Conditions Across Somaliland

Prevalence of Pediatric Surgical Conditions Across Somaliland

Global neurosurgery: models for international surgical education and collaboration at one university

Ethics in humanitarian efforts: when should resources be allocated to paediatric heart surgery?

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