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The Economic Value of the Delivery of Primary Cleft Surgery in Timor Leste 2000–2017

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Plastic and reconstructive surgical teams visiting from Australia, a high-income country, have delivered cleft surgical services to Timor Leste since 2000 on a volunteer basis. This paper aims to estimate the economic benefit of correcting cleft deformities in this new nation as it evolved its healthcare delivery service from independence in 1999.

Methods

We have utilised a prospective database of all cleft surgical interventions performed during 44 plastic surgical missions over the last 18 years. The disability-adjusted life year (DALY) framework was used to calculate the total DALYs averted by primary cleft lip and palate repair. The 2004 global burden of disease disability weights were used. Economic benefits were calculated using the gross national income (GNI) and the value of a statistical life (VSL) methods for Timor Leste. Estimates were adjusted for treatment effectiveness, counterfactual cases, and complications. Cost estimates included the local hospitalisation costs, the foregone salaries of the visiting surgeons and nurses, other costs associated with providing surgical care, and an estimate for foregone wages of the patients or their carers. Sensitivity analysis was performed with income elasticity set to 0.55, 1.0, and 1.5.

Results

During 44 visiting plastic surgical missions to Timor Leste, 1500 procedures were performed, including 843 primary cleft lip and palate operations. The cleft procedures resulted in the aversion of 842 DALYs and an economic return to Timor Leste of USD 2.2 million (GNI-based) or USD 197,917 (VSL-based). Our programme cost USD 705 per DALY averted. The economic return on investment was 0.3:1 (VSL-based) or 3.8:1 (GNI-based).

Conclusion

A sustained and consistent visiting team approach providing repair of cleft lip and palate defects has resulted in considerable economic gain for Timor Leste over an 18-year period. The training of a local surgeon and multidisciplinary team with ongoing support to the in-country cleft service is expected to reduce the cost per DALY averted once the surgeon and team are able to manage clefts independently.

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Acknowledgements

The authors wish to acknowledge the substantial and worthy contributions of the members of the surgical and nursing teams, both the Australian volunteer surgeons and the local teams.

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Authors and Affiliations

  1. Overseas Specialist Surgical Association of Australia (OSSAA), Adelaide, Australia

    Priya Nandoskar, Patrick Coghlan & Mark H. Moore

  2. Royal Australasian College of Surgeons (RACS), Melbourne, Australia

    Mark H. Moore & David A. Watters

  3. Hospital National Guido Valadares, Dili, Timor-Leste

    Joao Ximenes

  4. School of Medicine, Deakin University and Barwon Health, Geelong, Australia

    Eileen M. Moore & David A. Watters

  5. School of Population Health, University of Adelaide, Adelaide, Australia

    Jonathan Karnon

Authors
  1. Priya Nandoskar
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  2. Patrick Coghlan
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  3. Mark H. Moore
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  4. Joao Ximenes
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  5. Eileen M. Moore
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  6. Jonathan Karnon
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  7. David A. Watters
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Corresponding author

Correspondence to Eileen M. Moore.

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Nandoskar, P., Coghlan, P., Moore, M.H. et al. The Economic Value of the Delivery of Primary Cleft Surgery in Timor Leste 2000–2017. World J Surg 44, 1699–1705 (2020). https://doi.org/10.1007/s00268-020-05388-3

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  • DOI: https://doi.org/10.1007/s00268-020-05388-3

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