Skip to main content

Economic Valuation of the Global Burden of Cleft Disease Averted by a Large Cleft Charity

Abstract

Background

This study attempts to quantify the burden of disease averted through the global surgical work of a large cleft charity, and estimate the economic impact of this effort over a 10-year period.

Methods

Anonymized data of all primary cleft lip and cleft palate procedures in the Smile Train database were analyzed and disability-adjusted life years (DALYs) calculated using country-specific life expectancy tables, established disability weights, and estimated success of surgery and residual disability probabilities; multiple age weighting and discounting permutations were included. Averted DALYs were calculated and gross national income (GNI) per capita was then multiplied by averted DALYs to estimate economic gains.

Results

548,147 primary cleft procedures were performed in 83 countries between 2001 and 2011. 547,769 records contained complete data available for the study; 58 % were cleft lip and 42 % cleft palate. Averted DALYs ranged between 1.46 and 4.95 M. The mean economic impact ranged between USD 5510 and 50,634 per person. This corresponded to a global economic impact of between USD 3.0B and 27.7B USD, depending on the DALY and GNI values used. The estimated cost of providing these procedures based on an average reimbursement rate was USD 197M (0.7–6.6 % of the estimated impact).

Conclusions

The immense economic gain realized through procedures focused on a small proportion of the surgical burden of disease highlights the importance and cost-effectiveness of surgical treatment globally. This methodology can be applied to evaluate interventions for other conditions, and for evidence-based health care resource allocation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (2006) Global burden of disease and risk factors. Oxford University Press and The World Bank

  2. 2.

    Murray CJL, Salomon JA, Mathers C (2000) A critical examination of summary measures of population health. Bull WHO 78(8):981–994

    CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Gold MR, Stevenson D, Fryback DG (2002) HALYS AND QALYS AND DALYS, OHMY: similarities and differences in summary measures of population. HealthAnnu Rev Public Health 23:115–134

    Article  Google Scholar 

  4. 4.

    Corlew DS (2010) Estimation of impact of surgical disease through economic modeling of cleft lip and palate care. World J Surg 34(3):391–396

    Article  PubMed  Google Scholar 

  5. 5.

    Corlew D (2013) Economic modeling of surgical disease: a measure of public health interventions. World J Surg 37:1478–1485. doi:10.1007/s00268-012-1796-5

    Article  PubMed  Google Scholar 

  6. 6.

    Warf BC, Alkire BC, Bhai S, Hughes C, Schiff SJ, Vincent JR, Meara JG (2011) Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatr 8(5):509–521

    Article  PubMed  Google Scholar 

  7. 7.

    Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, Murray CJL, eds (2003). WHO Guide to cost—effectiveness analysis. Geneva, pp 1–239

  8. 8.

    Alkire B, Hughes CD, Nash K, Vincent JR, Meara JG (2011) Potential economic benefit of cleft lip and palate repair in sub-Saharan Africa. World J Surg 35(6):1194–1201. doi:10.1007/s00268-011-1055-1

    Article  PubMed  Google Scholar 

  9. 9.

    Alkire BC, Vincent JR, Burns CT, Metzler IS, Farmer PE, Meara JG (2012) Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention. PLoS ONE 7(4):e34595

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Poenaru D (2013) Getting the Job Done: analysis of the impact and effectiveness of the smiletrain program in alleviating the global burden of cleft disease. World J Surg 37(7):1562–1570. doi:10.1007/s00268-012-1876-6

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    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(1):83–92

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Smile Train: leading children’s charity. www.smiletrain.org. Accessed March 31, 2014

  13. 13.

    Shrime MG, Sleemi A, Ravilla TD (2015) Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 39:10–20. doi:10.1007/s00268-014-2516-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Murray CJL, Lopez A (1996) A comprehensive assessment of mortality and disability from disease, injures and risk factors in 1990 and projected to 2020. In The global burden of disease. Harvard University Press, Cambridge, pp 1–51

  15. 15.

    Bickler S, Ozgediz D, Gosselin R, Weiser T, Spiegel D, Hsia R, Dunbar P, McQueen K, Jamison D (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34(3):374–380. doi:10.1007/s00268-009-0261-6

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Lopez A (2006) Global burden of disease and risk factors. (Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, Eds. Oxford University Press & The World Bank, Library. New York

  17. 17.

    World Health Organization (2015) Standard Life Tables. Who.int/healthinfo/bodreferencesstandardlifetable.xls. Accessed Jan 21

  18. 18.

    Shillcutt SD, Clarke MG, Kingsnorth AN (2010) Cost-effectiveness of groin hernia surgery in the Western Region of Ghana. Arch Surg (Chicago, IL: 1960) 145(10):954–961

    Google Scholar 

  19. 19.

    Gosselin RA, Maldonado A, Elder G (2010) Comparative cost-effectiveness analysis of two MSF surgical trauma centers. World J Surg 34(3):415–419. doi:10.1007/s00268-009-0230-0

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    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(4):505–511. doi:10.1007/s00268-005-0609-5

    Article  PubMed  Google Scholar 

  21. 21.

    Wu VK, Poenaru D (2013) Burden of surgically correctable disabilities among children in the Dadaab Refugee Camp. World J Surg 37(7):1536–1543. doi:10.1007/s00268-012-1899-z

    Article  PubMed  Google Scholar 

  22. 22.

    Murray CJL, Lopez AD, Jamison DT (1994) The global burden of disease in 1990: summary results, sensitivity analysis and future direction. Bull WHO 72(3):495–509

    CAS  PubMed  PubMed Central  Google Scholar 

  23. 23.

    World Bank website: http://databank.worldbank.org/data/views/reports/tableview.aspx. Accessed Jan 21, 2015

  24. 24.

    Hughes CD et al (2012) The Clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings. PRS. doi:10.1097/PRS.0b013e318254b2a2

    Google Scholar 

  25. 25.

    Wilson J, Hodges A (2011) Cleft lip and palate surgery carried out by one team in Uganda: where have all the palates gone? Cleft Palate Craniofac J 49(3):1–7

    Google Scholar 

  26. 26.

    Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5(6):e121

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Shillcutt SD, Sanders DL, Teresa Butrón-Vila M, Kingsnorth AN (2013) Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador. World J Surg 37(1):32–41. doi:10.1007/s00268-012-1808-5

    Article  PubMed  Google Scholar 

  28. 28.

    Alkire B, Vincent J, Meara J (2014) Benefit-cost analysis of a cleft lip and palate surgical subspecialty hospital in India. In DCP3 draft, pp 1–17

  29. 29.

    Moon W, Perry H, Baek R-M (2012) 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. doi:10.1007/s00268-012-1761-3

    Article  PubMed  Google Scholar 

  30. 30.

    Gosselin R, Ozgediz D, Poenaru D (2013) A square peg in a round hole? challenges with DALY-based “burden of disease” calculations in surgery and a call for alternative metrics. World J Surg 37(11):2507–2511. doi:10.1007/s00268-013-2182-7

    Article  PubMed  Google Scholar 

  31. 31.

    Higashi H, Barendregt JJ, Kassebaum NJ, Weiser TG, Bickler SW, Vos T (2015) The burden of selected congenital anomalies amenable to surgery in low and middle-income regions: cleft lip and palate, congenital heart anomalies and neural tube defects. Arch Dis Child 100:233–238

    Article  PubMed  Google Scholar 

  32. 32.

    Bloom DE and Canning D (2008), Population health and economic growth, Working paper 24, Commission on Growth and Development, The World Bank

  33. 33.

    Banerjee AV, Duflo E (2012) Poor economics: a radical rethinking of the way to fight global poverty, Public Affairs

Download references

Acknowledgments

The authors express their appreciation to MacKinnon Engen of The Smile Train for making the database available and facilitating our analysis.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Scott Corlew.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Poenaru, D., Lin, D. & Corlew, S. Economic Valuation of the Global Burden of Cleft Disease Averted by a Large Cleft Charity. World J Surg 40, 1053–1059 (2016). https://doi.org/10.1007/s00268-015-3367-z

Download citation

Keywords

  • Cleft Palate
  • Purchasing Power Parity
  • Disability Weight
  • Gross National Income
  • Cleft Palate Repair