Skip to main content

Advertisement

SpringerLink
Log in

Is International Volunteer Surgery for Cleft Lip and Cleft Palate a Cost-Effective and Justifiable Intervention? A Case Study from East Asia

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Although surgery provided by international volunteers is increasingly common in the developing world, there have been few assessments of the cost-effectiveness of these activities. In this context, this study covered 15 years of experience of one international nongovernmental organization, Smile for Children, in providing cleft lip (CL) and cleft palate (CP) surgical services in Vietnam.

Methods

We analyzed the cost-effectiveness of the program and its contributions to building local capacity. To assess the cost-effectiveness of CL/CP surgery performed during Smile for Children’s missions in Vietnam, we analyzed the data from four annual missions, from 2007 to 2010. According to the 2003 World Health Organization Guide to Cost-Effectiveness Analysis, we calculated cost per disability-adjusted life years (DALYs) averted with and without age weighting. For the data from the 2010 mission, we repeated the same calculation but with and without considering opportunity cost for labor.

Results

The discounted cost per DALY averted averaged $68, ranging from $52 to $79 depending on the year of the mission. The average discounted cost per DALY averted with age weighting was $56 (range $43–$65). For the calculation that takes into account the volunteers’ possible income loss as the labor cost of the mission in 2010, the cost per DALY averted without age weighting increased by 28 %, from $76 to $97; and the cost per DALY averted with age weighting increased by 27 %, from $63 to $80. Under all of these varying assumptions, the CL/CP program operated by Smile for Children is a cost-effective intervention using international criteria for cost-effectiveness.

Conclusions

The contribution of the international volunteer surgical team to building in-country capacity is notable. It was achieved primarily through training Vietnamese surgeons during the mission trips and through sending these surgeons to Korea for training. Other staff, including anesthesiologists, were also trained; and equipment and supplies were provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Maki J, Qualls M, White B et al (2008) Health impact assessment and short-term medical mission: a methods study to evaluate quality of care. BMC Health Serv Res 8:121

    Article  PubMed  Google Scholar 

  2. Laleman G, Kegels G, Marchal B et al (2007) The contribution of international health volunteers to the health workforce in sub-Saharan Africa. Hum Resour Health 5:19

    Article  PubMed  Google Scholar 

  3. Magee WP Jr, Vander Burg R, Hatcher KW (2010) CL/CP as a cost-effective health care treatment in the developing world. World J Surg 34:420–427. doi:10.1007/s00268-009-0333-7

    Article  PubMed  Google Scholar 

  4. Gosselin RA, Maldonado A, Elder G et al (2010) Comparative cost-effectiveness analysis of two MSF surgical trauma centers. World J Surg 34:415–419. doi:10.1007/s00268-009-0230-0

    Article  PubMed  Google Scholar 

  5. World Bank (2010) World Development Indicators 2010. World Bank, Washington DC

  6. UNICEF (2011) Vietnam country profile - maternal, newborn & child survival. http://www.childinfo.org/files/maternal/DI%20Profile%20-%20Vietnam.pdf. Accessed 20 June 2011

  7. Hopper RA, Cutting C, Grayson B (2007) Cleft lip and cleft palate. In: Grabb and Smith’s plastic surgery. Wolters Kluwer Health/Lippincott Williams & Wilkins, Ambler, p 929

  8. Luboga S, Macfarlane SB, von Schreeb J et al (2009) Increasing access to surgical services in sub-Saharan Africa: priorities for national and international agencies recommended by the bellagio essential surgery group. PLoS Med 6(12):e1000200. doi:10.1371/journal.pmed.10002004

  9. Kushner AL, Kamara TB, Groen RS et al (2010) Improving access to surgery in a developing country: experience from a surgical collaboration in Sierra Leone. J Surg Educ 67:270–273

    Article  PubMed  Google Scholar 

  10. Mars M, Sell D, Habel A (2008) Speech therapy delivery and cleft lip and palate in the developing world. Wiley, New York, pp 193–202

    Book  Google Scholar 

  11. Ruiz-Razura A, Cronin ED, Navarro CE (2000) Creating long-term benefits in cleft lip and palate volunteer missions. Plast Reconstr Surg 105:195–201

    Article  PubMed  CAS  Google Scholar 

  12. Murray CJ, Evans DB, Acharya A et al (2000) Development of WHO guidelines on generalized cost-effectiveness analysis, health economics. Health Econ 9:235–251

    Article  PubMed  CAS  Google Scholar 

  13. Karlsson G, Johannesson M (1998) Cost-effectiveness analysis and capital costs. Soc Sci Med 46:1183–1191

    Article  PubMed  CAS  Google Scholar 

  14. Mathers CD, Lopez AD, Murray CJL (2006) The burden of disease and mortality by condition: data, methods, and results for 2001. In: Global burden of disease and risk factors. World Bank, Washington DC, p 45–50

  15. Mathers CD, Salomon JA (2008) Sensitivity and uncertainty analyses for burden of disease and risk factor estimates 2008. In: Global burden of disease and risk. World Bank, Washington DC, p 28

  16. Zhang P, Woodward M, Shen J et al (2010) Individual disability-adjusted life year: a summary health outcome indicator used for prospective studies. In: Handbook of disease burden and quality of life measures. Springer, New York, p 425–436

  17. Murray CJL, Lopez AD (1996) A comprehensive assessment of mortality and disability from disease, injures and risk factors in 1990 and projected to 2020. In: Global burden of disease. Harvard University Press, Cambridge

  18. Musgrove P, Fox-Rushby J (2006) Cost-effectiveness analysis for priority setting: disease control priorities in developing countries, 2nd edn. World Bank, Washington DC, pp 271–285

    Google Scholar 

  19. World Health Organization (2004) The Global burden of disease: 2004 update. World Health Organization, Geneva

  20. Christensen K, Jel K, Herskind A et al (2004) Long term follow up study of survival associated with cleft lip and palate at birth. BMJ 328:1405

    Article  PubMed  Google Scholar 

  21. World Health Organization (2008) Life table for WHO member states. http://apps.who.int/ghodata/?vid=72/. Accessed 28 Aug 2010

  22. World Health Organization (2001) National burden of disease study, a practical guideline. World Health Organization, Geneva, pp 117–121

    Google Scholar 

  23. World Bank (2006) Disease Control Priorities Project. http://www.dcp2.org/page/main/BrowseInterventions.html/. Accessed 15 Oct 2010

  24. Sachs JD (2001) Macroeconomics and health: investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health World Health Organization. World Health Organization, Geneva

  25. World Bank (2010) World Development Report. World Bank, Washington DC

  26. US Bureau of Labor Statistics CPI Inflation Calculator. http://www.bls.gov/data/inflation_calculator.html/. Accessed 15 Oct 2010

  27. Debas H, Gosselin RA, McCord C et al (2006) Surgery. In: Jamison D, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries. World Bank, Washington DC, pp 1245–1260

    Google Scholar 

  28. McCord C, Chowdhury Q (2003) A cost-effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81:83–92

    Article  PubMed  CAS  Google Scholar 

  29. Gosselin RA, Thind A, Bellardinelli A (2006) Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services? World J Surg 30:505–511. doi:10.1007/s00268-005-0609-5

    Article  PubMed  Google Scholar 

  30. Gosselin RA, Heitto M (2008) Cost-effectiveness of a district trauma hospital in Battambang, Cambodia. World J Surg 32:2450–2453. doi:10.1007/s00268-008-9708-4

    Article  PubMed  Google Scholar 

  31. Salomon JA (2010) New disability weights for the global burden of disease. Bull World Health Organ 99:879

    Article  Google Scholar 

  32. Ivers LC, Garfein ES, Augustin J et al (2008) Increasing access to surgical service for the poor in rural Haiti: surgery as a public good for public health. World J Surg 32:537–542. doi:10.1007/s00268-008-9527-7

    Article  PubMed  Google Scholar 

  33. Uetani M, Jimba M, Niimi T et al (2006) Effects of a long-term volunteer surgical program in developing country: the case in Vietnam from 1993 to 2003. Cleft Plate Craniofac J 43:616–619

    Article  Google Scholar 

  34. Riviello R, Orgediz D, Hsia RY et al (2010) Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg 34:459–465. doi:10.1007/s00268-009-0360-4

    Article  PubMed  Google Scholar 

  35. Chung KC, Kotisis SV (2007) Teaching pediatric hand surgery in Vietnam. Hand 2:16–24

    Article  PubMed  Google Scholar 

  36. Rohrich RJ, Love EJ, Byrd HS et al (2000) Optimal timing of cleft palate closure. Plast Reconstr Surg 106:412–421

    Google Scholar 

  37. Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet 372:139–144

    Article  PubMed  Google Scholar 

  38. Mont D (2007) Measuring health and disability. Lancet 369:1658–1663

    Article  PubMed  Google Scholar 

  39. Peter AM, Julian L, Ron GM et al (2009) Cleft lip and palate. Lancet 374:1773–1785

    Article  Google Scholar 

Download references

Acknowledgments

We thank the following people for their contributions to this study: Dr. Semin Baek, a founder of Smile for Children, for providing us with background information and access to data; Dr. Fizan Abdullah for his contributions to the design of the study and interpretation of the data; Samuel Schillcutt for assistance with the data analysis methods; Dr. Daniel Rhee for his review of the manuscript; and Dr. Vu Ngoc Lam for his assistance in obtaining data for this study and in interpretation of the findings. We are also grateful for the helpful comments made by anonymous reviewers.

Author information

Authors and Affiliations

  1. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21210, USA

    Woori Moon

  2. Department of International Health, Room E8537, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21210, USA

    Henry Perry

  3. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea

    Rong-Min Baek

Authors
  1. Woori Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry Perry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rong-Min Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry Perry.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moon, W., Perry, H. & Baek, RM. Is International Volunteer Surgery for Cleft Lip and Cleft Palate a Cost-Effective and Justifiable Intervention? A Case Study from East Asia. World J Surg 36, 2819–2830 (2012). https://doi.org/10.1007/s00268-012-1761-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1761-3

Keywords

Search

Navigation