title: Measuring and Comparing the Cost-Effectiveness of Surgical Care Delivery in Low-Resource Settings: Cleft Lip and Palate as a Model.
abstract: Cleft lip and palate (CLP) care is the longest sustained global effort in humanitarian surgical care. However, the relative cost-effectiveness of surgical delivery approaches remains largely unknown. We assessed the cost-effectiveness of two strategies of CLP surgical care delivery in low resource settings: medical mission and comprehensive care center. We evaluated the medical records and costs for 17 India-based medical missions and a Comprehensive Cleft Care Center in Guwahati, India, from Operation Smile, a humanitarian nongovernmental organization. Age, sex, diagnosis, and procedures were extracted and cost/Disability-Adjusted Life Year (DALY) averted was calculated using a provider's perspective. The disability weights for CLP from the Global Burden of Disease (GBD) 2010 update were used as the reference case. Sensitivity analysis was performed using various disability weights, age-weighting, discounting, and cost perspective. The medical missions treated 3503 patients for first-time cleft procedures and averted 6.00 DALYs per intervention with a cost-effectiveness of $247.42/DALY. The care center cohort included 2778 patients with first-time operations for CLP and averted a mean of 5.96 DALYs per intervention with a cost-effectiveness of $189.81/DALY. The Incremental Cost-Effectiveness Ratio (ICER) of choosing medical mission over care center is $462.55. The care center provides cleft care with a higher cost-effectiveness, although both models are highly cost-effective in India, in accordance with WHO guidelines. Compared to other global health interventions, cleft care is very cost-effective and investment in cleft surgery might be realistic and achievable in similar resource-constrained environments.
authors.affiliation: *Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA †Operation Smile Inc, Virginia Beach, VA ‡Center for Health Decision Science, Harvard School for Public Health, Boston, MA §Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT ||Guwahati Cleft Care Center, Operation Smile India, Guwahati, India ¶Department of Cranio-Maxillofacial Surgery, University Hospital Giessen, Giessen, Germany #Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Berit
authors.initials: B
authors.lastname: Hackenberg
authors.forename: Margarita S
authors.initials: MS
authors.lastname: Ramos
authors.forename: Alexander
authors.initials: A
authors.lastname: Campbell
authors.forename: Stephen
authors.initials: S
authors.lastname: Resch
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
authors.forename: Hiteswar
authors.initials: H
authors.lastname: Sarma
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Howaldt
authors.forename: E J
authors.initials: EJ
authors.lastname: Caterson
mesh_terms: D000533:Altruism; D002648:Child; D002971:Cleft Lip / Q000191:economics / Q000601:surgery*; D002972:Cleft Palate / Q000191:economics / Q000601:surgery*; D003191:Comprehensive Health Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007194:India; D008297:Male; D008493:Medical Missions / Q000191:economics*; D008962:Models, Theoretical