Barclay T Stewart1, Adam L Kushner2, Thaim B Kamara3, Sunil Shrestha4, Shailvi Gupta5, Reinou S Groen6, Ben Nwomeh7, Richard A Gosselin8, David Spiegel9. 1. Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: stewarb@uw.edu. 2. Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA. 3. Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; Ministry of Health and Sanitation, Freetown, Sierra Leone. 4. Department of Surgery, Nepal Medical College, Kathmandu, Nepal. 5. Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, University of California San Francisco East Bay, Oakland, CA, USA. 6. Surgeons OverSeas (SOS), New York, NY, USA; Department of Obstetrics and Gynecology, Johns Hopkins Hospital, Baltimore, MD, USA. 7. Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA. 8. School of Public Health, University of California, Berkeley, CA, USA; Institute for Global Orthopedics and Traumatology, Orthopaedic Department, University of California, San Francisco, USA. 9. Division of Orthopedic Surgery, Children's Hospital of Philadelphia, PA, USA; Hospital and Rehabilitation Centre for Disabled Children, Janagal, Banepa, Kavre, Nepal.
Abstract
BACKGROUND: The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e., a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or premature death; DALYs) in Sierra Leone and Nepal. METHODS: Data from nationwide, cluster-randomized, community-based surveys of surgical need in Sierra Leone and Nepal were used to model the incidence and prevalence of fractures stratified by met and unmet needs. DALYs incurred from treated and untreated fractures were estimated. Additionally, the investment necessary to eliminate avertable incident fracture DALYs was modeled through 2025 using published cost per DALY averted estimates. RESULTS: The incidence of treated and untreated fractures in Sierra Leone was 570 and 1004 fractures per 100,000 persons, respectively. There could be more than 2 million avertable fracture DALYs by 2025 in Sierra Leone and 2.5 million in Nepal requiring an estimated US$ 4,049,932 (range US$ 2,011,500-6,088,364) and US$ 4,962,402 (range US$ 2,464,701-7,460,103) to address this excess burden, respectively. CONCLUSION: This study identified a significant burden of untreated fractures in both countries, and an opportunity to avert more than 4.5 million DALYs in 10 years in a cost-effective manner. Prioritizing funding mechanisms for orthopaedic care and implants should be considered given the large burden of untreated fractures found in both countries and the long-term savings and functional benefit from properly treated fractures.
RCT Entities:
BACKGROUND: The burden of injury is increasing worldwide; planning for its impact on population health and health systems is urgently needed, particularly in low- and middle-income countries (LMICs). This study aimed to model the burden of fractures and project costs to eliminate avertable fracture-related disability-adjusted life-years (i.e., a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or premature death; DALYs) in Sierra Leone and Nepal. METHODS: Data from nationwide, cluster-randomized, community-based surveys of surgical need in Sierra Leone and Nepal were used to model the incidence and prevalence of fractures stratified by met and unmet needs. DALYs incurred from treated and untreated fractures were estimated. Additionally, the investment necessary to eliminate avertable incident fracture DALYs was modeled through 2025 using published cost per DALY averted estimates. RESULTS: The incidence of treated and untreated fractures in Sierra Leone was 570 and 1004 fractures per 100,000 persons, respectively. There could be more than 2 million avertable fracture DALYs by 2025 in Sierra Leone and 2.5 million in Nepal requiring an estimated US$ 4,049,932 (range US$ 2,011,500-6,088,364) and US$ 4,962,402 (range US$ 2,464,701-7,460,103) to address this excess burden, respectively. CONCLUSION: This study identified a significant burden of untreated fractures in both countries, and an opportunity to avert more than 4.5 million DALYs in 10 years in a cost-effective manner. Prioritizing funding mechanisms for orthopaedic care and implants should be considered given the large burden of untreated fractures found in both countries and the long-term savings and functional benefit from properly treated fractures.
Authors: Arjan J Knulst; Shailvi Gupta; Reinou S Groen; Dipak Maharjan; Amatya S Kapendra; Jenny Dankelman; Adam L Kushner Journal: Trop Med Int Health Date: 2019-08-06 Impact factor: 2.622
Authors: Amrit Virk; Mohamed Bella Jalloh; Songor Koedoyoma; Isaac O Smalle; William Bolton; J A Scott; Julia Brown; David Jayne; Tim Ensor; Rebecca King Journal: BMJ Open Date: 2021-03-01 Impact factor: 2.692
Authors: Daniella M Cordero; Theodore A Miclau; Alexandra V Paul; Saam Morshed; Theodore Miclau; Claude Martin; David W Shearer Journal: OTA Int Date: 2020-04-23