title: Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.
abstract: BACKGROUND
  Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs).
  
  
  METHODS
  We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.
  
  
  RESULTS
  We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.
  
  
  CONCLUSIONS
  Our findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.
authors: Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America.
authors: Anthony T
authors: http://orcid.org/0000-0002-1203-8896
authors: AT
authors: Saxton
authors: McMaster Paediatric Surgery Research Collaborative, Dept. of Surgery, McMaster University, Hamilton, Canada.
authors: Dan
authors: D
authors: Poenaru
authors: Yale-New Haven Hospital, New Haven, CT, United States of America.
authors: Doruk
authors: D
authors: Ozgediz
authors: Department of Surgery, National Hospital, Abuja, Nigeria.
authors: Emmanuel A
authors: EA
authors: Ameh
authors: University of California-Davis Health System, Davis, CA, United States of America.
authors: Diana
authors: D
authors: Farmer
authors: Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America.
authors: Emily R
authors: ER
authors: Smith
authors: Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America.
authors: Henry E
authors: HE
authors: Rice
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D004185:Disability Evaluation; D006801:Humans; D013514:Surgical Procedures, Operative / Q000191:economics*