Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review
- 1.8k Downloads
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.
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.
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).
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.
KeywordsCataract Surgery Clubfoot Surgical Care Male Circumcision Trachoma
Conflict of interest
- 2.Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB et al (eds) Disease control priorities in developing countries, vol 2. The World Bank/Oxfprd University Press, Washington, DCGoogle Scholar
- 7.Outcome of Copenhagen Consensus (2008). http://www.copenhagenconsensus.com/Home.aspx. Accessed 3 Feb 2013
- 12.CHOosing Interventions that are Cost Effective (WHO-CHOICE) (2005) Purchasing power parity. http://www.who.int/choice/costs/ppp/en/. Accessed 31 June 2013
- 16.CHOosing Interventions that are Cost Effective (WHO-CHOICE). http://www.who.int/choice/. Accessed 31 June 2013
- 38.Laxminarayan R, Chow J, Shahid-Salles SA (2006) Intervention cost-effectiveness: overview of main messages. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB et al (eds) Disease Control Priorities in Developing Countries, vol 2. World Bank/Oxford University Press, Washington, DCGoogle Scholar
- 40.Barnighausen T, Bloom DE, Humair S (2011) Going horizontal—shifts in funding of global health interventions. N Engl J Med 364:2173–2181Google Scholar
- 41.Edejer T, Baltussen R, Adam T et al (2003) WHO guide to cost-effectiveness analysis. World Health Organisation, GenevaGoogle Scholar