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Showing content from https://pubmed.ncbi.nlm.nih.gov/25103302/ below:

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

Review

doi: 10.1016/S2214-109X(14)70213-X. Epub 2014 May 21. Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis

Affiliations

¹ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: tchao@partners.org.
² Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA.
³ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; University of Miami Miller School of Medicine, Miami, FL, USA.
⁴ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Pediatric Surgery, Lund University Children's Hospital, Lund, Sweden; Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
⁵ Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
⁶ Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.

PMID: 25103302
DOI: 10.1016/S2214-109X(14)70213-X

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Review

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

Tiffany E Chao et al. Lancet Glob Health. 2014 Jun.

Free article doi: 10.1016/S2214-109X(14)70213-X. Epub 2014 May 21. Affiliations

¹ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: tchao@partners.org.
² Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA.
³ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; University of Miami Miller School of Medicine, Miami, FL, USA.
⁴ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Pediatric Surgery, Lund University Children's Hospital, Lund, Sweden; Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
⁵ Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA.
⁶ Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.

PMID: 25103302
DOI: 10.1016/S2214-109X(14)70213-X

Item in Clipboard

Abstract

Background: The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery.

Methods: We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US$. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist.

Findings: Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision ($13·78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations ($12·96-25·93 per DALY) and bednets for malaria prevention ($6·48-22·04 per DALY). Median CERs of cleft lip or palate repair ($47·74 per DALY), general surgery ($82·32 per DALY), hydrocephalus surgery ($108·74 per DALY), and ophthalmic surgery ($136 per DALY) were similar to that of the BCG vaccine ($51·86-220·39 per DALY). Median CERs of caesarean sections ($315·12 per DALY) and orthopaedic surgery ($381·15 per DALY) are more favourable than those of medical treatment for ischaemic heart disease ($500·41-706·54 per DALY) and HIV treatment with multidrug antiretroviral therapy ($453·74-648·20 per DALY).

Interpretation: Our findings suggest that many essential surgical interventions are cost-effective or very cost-effective in resource-poor countries. Quantification of the economic value of surgery provides a strong argument for the expansion of global surgery's role in the global health movement. However, economic value should not be the only argument for resource allocation--other organisational, ethical, and political arguments can also be made for its inclusion.

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