Getting the Job Done: Analysis of the Impact and Effectiveness of the SmileTrain Program in Alleviating the Global Burden of Cleft Disease
- 586 Downloads
The study measured the success of SmileTrain, the largest cleft charity globally, in alleviating the global burden of disease (GBD). It was done by estimating averted disability-adjusted life years (DALYs) and delayed averted DALYs because of the global backlog in cleft procedures.
Anonymized data for all procedures in the SmileTrain global database were analyzed by age, sex, country, region, and surgery type. DALYs averted were calculated using life expectancy tables and established and estimated disability weights. The cost-effectiveness analysis used mean SmileTrain procedural disbursement figures. Sensitivity analysis was performed using various cleft incidence rates, life expectancy tables, and disability weights.
During 2003–2010 a total of 536,846 operations were performed on 364,467 patients—86 % in Southeast Asia and the western Pacific region. Procedure numbers increased yearly. Mean age at primary surgery—6.2 years (9.8 years in Africa)—remained fairly constant over time in each region. Globally, 2.1–4.7 million DALYs were averted through the operations at a total estimated cost of US$196 M. Mean DALYs per patient were 3.8–9.0, and mean cost per DALY was $72–$134. Total delayed GBD due to advanced age at surgery was 191,000–457,000 DALYs.
Despite an unparalleled number of surgeries performed and yearly increase by one charity, the unmet and delayed averted cleft GBD remains significant in all regions. Large geographic disparities reflect varied challenges regarding access to surgery. Cleft surgeries are cost-effective interventions to reduce the global burden of disease (GBD). Future challenges include increased collaboration among cleft care providers and a focus on remote global areas by building infrastructure and local training.
KeywordsCleft Palate Disability Weight Western Pacific Region Year Live With Disability Cleft Palate Repair
We thank the SmileTrain NYC head office staff for providing the database and for their expert advice and enthusiastic support. We also acknowledge the expert advice of Drs. Andrew Hodges (CoRSU, Kampala, Uganda), Richard Gosselin (School of Public Health, Berkeley University, El Granada, CA), Scott Corlew (ReSurg International), and Doruk Ozgediz (Global Partners in Anesthesia and Surgery).
Conflict of interest
The author declares no conflicts of interest in this work.
- 3.Anonymous (2012) SmileTrain Mission. http://www.smiletrain.org/about/. Accessed 4 Jan 2012
- 7.Anonymous (2012) Country profiles of environmental burden of disease by WHO regions. http://www.who.int/quantifying_ehimpacts/national/countryprofile/regions/en/index.html. Accessed 4 Jan 2012
- 8.Lopez AD, Mathers CD, Ezzati M et al (eds) (2006) Global Burden of Disease and Risk Factors. Oxford University Press, New YorkGoogle Scholar
- 9.World Health Organization (2012) Life tables for WHO Member States. http://www.who.int/healthinfo/statistics/mortality_life_tables/en/. Accessed 4 Jan 2012
- 25.Bellagio Working Group (2007) Increasing access to surgical services in resource-constrained settings in Sub-Saharan Africa. In: Proceedings of a conference at the Rockefeller Foundation, Bellagio Conference Center, pp 1–72Google Scholar
- 27.Anonymous (2012) Indian medical tourism destination: India emerges hot destination for medical tourism—more than 100 per cent jump likely in Kenyan patients opting for treatment in India in 2011. http://www.businesswireindia.com/PressRelease.asp?b2mid=26376/. Accessed 10 Jan 2012
- 28.Edejer TT, Evans D, Lowe J (2002) World health report, p 108. http://www.who.int/whr/2002/en/whr02_en.pdf/. Accessed 4 Jan 2012