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What is the Cost of Free Cleft Surgery in the Middle East?

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This project explores the costs of cleft lip and/or palate surgeries in Palestine and Sudan, two low- and middle-income countries (LMIC), in the Middle East. Our purpose is to examine the veracity of advertisements from international cleft organizations claiming that “250 US dollars (USD) covers the cost of a single cleft surgery.” We hypothesize that the actual cost of surgery is greater than 250 USD.


Costs for each cleft surgery were organized broadly into 5 categories: hospital charges, personnel (time and money spent for health professionals to travel to LMIC, including lost wages), tests, consumables, and reusables. Each item was priced at market value during the time of data collection. Following itemization of actual costs, we compared the costs per cleft surgery among four surgical practice models: (1) visiting international surgical teams, (2) visiting international surgeon working with local teams, (3) local teams working at government hospitals, and (4) local teams working at private hospitals.


Our results suggest that 250 USD is an underestimate of actual costs per cleft surgery in all models. The most expensive model in both Palestine and Sudan was the first model, visiting international teams performing all team functions; the cheapest surgical model in both countries was a local team working at government hospitals. The largest cost for any of these models is travel and lost wages for international team members. Eliminating this single cost (travel) decreases overall cost tremendously, but still does not approach the advertised cost of 250 USD.


We conclude that 250 USD underestimates the actual costs to perform a single cleft surgery in Palestine and Sudan. If international cleft organizations are genuinely committed to creating sustainable international cleft programs, they should focus exclusively on training local professionals to perform surgery in hospitals of their own choosing.

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  1. Smile Train (2016) Cleft repair surgery, costing $250, contributes up to $50,000 to local economy

  2. Operation Smile:

  3. Magee WP et al (2010) Cleft lip and palate as a cost-effective health care treatment in the developing world. World J Surg. doi:10.1007/s00268-009-0333-7

    Google Scholar 

  4. Kupfer P et al (2012) Cost differences between anterior and posterior approaches in cleft lip/palate. J Oral Maxillofac Surg 70:685–689

    Article  PubMed  Google Scholar 

  5. Allareddy V et al (2012) Factors associated with hospitalization charges for cleft palate repairs and revisions. J Oral Maxillofac Surg 70(8):1968–1977

    Article  PubMed  Google Scholar 

  6. Albino FP, Koltz PF, Girotto JA (2010) Predicting out-of-pocket costs in the surgical management of orofacial clefts. Plast Reconstr Surg 126(4):188e–189e

    Article  PubMed  Google Scholar 

  7. Yazdy MM, Honein MA, Rasmussen SA, Frias JL (2007) Priorities for future public health research in orofacial clefts. Cleft Palate Craniofac J 44:351–357

    Article  PubMed  Google Scholar 

  8. American Society of Plastic Surgeons, National Clearing house of Plastic Surgery Statistics. 2009 Report of the 2008 Statistics

  9. Boulet SL, Grosse SD, Honein MA, Correa-Villaseñor A (2009) Children with orofacial clefts: health-care use and costs among a privately insured population. Public Health Rep 124:447–453

    Article  PubMed  PubMed Central  Google Scholar 

  10. Abbott MM, Meara JG (2011) A microcosting approach for isolated, unilateral cleft lip care in the first year of life. Plast Reconstr Surg 127(1):333–339

    Article  CAS  PubMed  Google Scholar 

  11. XE Currency Converter: USD to SDG. XE: Convert USD/SDG. United States Dollar to Israel Shekel. XE Currency Converter

  12. XE Currency Converter: USD to SDG. XE: Convert USD/SDG. United States Dollar to Sudan Pound. XE Currency Converter

  13. Purchasing-power parity. World Bank Data Repository.,

  14. Shrime MG et al (2017) Cost-effectiveness in global surgery: pearls, pitfalls, and a checklist. World J Surg 41(6):1401–1413. doi:10.1007/s00268-017-3875-0

    Article  PubMed  Google Scholar 

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We would like to acknowledge funding from the NIDCR through an R56 mechanism for the grant entitled “Oral-facial Clefts: Discovery and Characterization of New Genes mechanism,” the United Palestinian Appeal based in Washington, DC, USA (; the Sudanese American Medical Association, based in Wichita, Kansas, USA ( A very special thanks to the local cleft team members in both Palestine and Sudan.

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Correspondence to John A. van Aalst.

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Sheriff, S., Zawahrah, H.J., Chang, L.V. et al. What is the Cost of Free Cleft Surgery in the Middle East?. World J Surg 42, 1239–1247 (2018).

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