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Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review

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Abstract

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 US$5.06–$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88–$78.18), male circumcision (cost/DALY averted range US$7.38–$319.29), emergency cesarean section (cost/DALY averted range US$18–$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44–$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78–$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00–$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00).

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.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Kings Centre for Global Health, Kings College, London, UK

    Caris E. Grimes

  2. Department of General Surgery, East Surrey Hospital, Redhill, Surrey, RH1 5RH, UK

    Caris E. Grimes

  3. University of California Berkeley School of Public Health, Berkeley, CA, USA

    Jaymie Ang Henry

  4. Institute for Global Orthopaedics and Traumatology (IGOT), San Francisco, CA, USA

    Jaymie Ang Henry

  5. East of England Deanery, Essex, UK

    Jane Maraka

  6. College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi

    Nyengo C. Mkandawire

  7. A&E Department, University Hospital of Canton Vaud, 1011, Lausanne, Switzerland

    Michael Cotton

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  1. Caris E. Grimes
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  2. Jaymie Ang Henry
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  3. Jane Maraka
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  4. Nyengo C. Mkandawire
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  5. Michael Cotton
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Correspondence to Caris E. Grimes.

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Grimes, C.E., Henry, J.A., Maraka, J. et al. Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review. World J Surg 38, 252–263 (2014). https://doi.org/10.1007/s00268-013-2243-y

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