title: Getting the job done: analysis of the impact and effectiveness of the SmileTrain program in alleviating the global burden of cleft disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: BethanyKids at Kijabe Hospital, Box 20, Kijabe 00220, Kenya. dpoenaru@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Poenaru
mesh_terms: D002608:Charities / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D014943:Global Health; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D015397:Program Evaluation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000191:economics / Q000706:statistics & numerical data*