BACKGROUND: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. METHODS: PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. RESULTS: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). CONCLUSIONS: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies.
BACKGROUND: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. METHODS: PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. RESULTS: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). CONCLUSIONS: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies.
Authors: Charles Mock; Meena Cherian; Catherine Juillard; Peter Donkor; Stephen Bickler; Dean Jamison; Kelly McQueen Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: Ronald H Gray; Xianbin Li; Godfrey Kigozi; David Serwadda; Fred Nalugoda; Stephen Watya; Steven J Reynolds; Maria Wawer Journal: AIDS Date: 2007-04-23 Impact factor: 4.177
Authors: Charles N Mock; Peter Donkor; Atul Gawande; Dean T Jamison; Margaret E Kruk; Haile T Debas Journal: Lancet Date: 2015-02-05 Impact factor: 79.321
Authors: Barclay T Stewart; Evan Wong; Shailvi Gupta; Santosh Bastola; Sunil Shrestha; Adam L Kushner; Benedict C Nwomeh Journal: Surgery Date: 2015-05 Impact factor: 3.982
Authors: Barclay T Stewart; Isaac Kofi Yankson; Francis Afukaar; Martha C Hijar Medina; Pham Viet Cuong; Charles Mock Journal: Med Clin North Am Date: 2016-03 Impact factor: 5.456
Authors: James Ankomah; Barclay T Stewart; Victor Oppong-Nketia; Adofo Koranteng; Adam Gyedu; Robert Quansah; Peter Donkor; Francis Abantanga; Charles Mock Journal: J Pediatr Surg Date: 2015-03-26 Impact factor: 2.545
Authors: Jaymie Ang Henry; Chris Bem; Caris Grimes; Eric Borgstein; Nyengo Mkandawire; William E G Thomas; S William A Gunn; Robert H S Lane; Michael H Cotton Journal: World J Surg Date: 2015-04 Impact factor: 3.352