5 research outputs found
Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.
BACKGROUND: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions.
METHODS: PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies.
RESULTS: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US106.00), elective inguinal hernia repair (cost/DALY averted range US78.18), male circumcision (cost/DALY averted range US319.29), emergency cesarean section (cost/DALY averted range US3,462.00), and cleft lip and palate repair (cost/DALY averted range US96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US32.78-1,062.00), vitamin A supplementation (US12.00), breast feeding promotion (US922.00).
CONCLUSIONS: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies