Mark G Shrime1,2, Blake C Alkire3,4, Caris Grimes5, Tiffany E Chao6, Dan Poenaru7,8,9, Stéphane Verguet10. 1. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. shrime@mail.harvard.edu. 2. Office of Global Surgery and Health, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. shrime@mail.harvard.edu. 3. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. 4. Office of Global Surgery and Health, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. 5. Kings Centre for Global Health and Kings Health Partners, Kings College, London, UK. 6. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 7. MyungSung Medical College, Addis Ababa, Ethiopia. 8. Montreal Children's Hospital, Montreal, Canada. 9. Department of Surgery, McGill University, Montreal, Canada. 10. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Abstract
INTRODUCTION: Cost-effectiveness analysis can be a powerful policy-making tool. In the two decades since the first cost-effectiveness analyses in global surgery, the methodology has established the cost-effectiveness of many types of surgery in low- and middle-income countries (LMICs). However, with the crescendo of cost-effectiveness analyses in global surgery has come vast disparities in methodology, with only 15% of studies adhering to published guidelines. This has led to results that have varied up to 150-fold. METHODS: The theoretical basis, common pitfalls, and guidelines-based recommendations for cost-effectiveness analyses are reviewed, and a checklist to be used for cost-effectiveness analyses in global surgery is created. RESULTS: Common pitfalls in global surgery cost-effectiveness analyses fall into five categories: the analytic perspective, cost measurement, effectiveness measurement, probability estimation, valuation of the counterfactual, and heterogeneity and uncertainty. These are reviewed in turn, and a checklist to avoid these pitfalls is developed. CONCLUSION: Cost-effectiveness analyses, when done rigorously, can be very useful for the development of efficient surgical systems in LMICs. This review highlights the common pitfalls in these analyses and methods to avoid these pitfalls.
INTRODUCTION: Cost-effectiveness analysis can be a powerful policy-making tool. In the two decades since the first cost-effectiveness analyses in global surgery, the methodology has established the cost-effectiveness of many types of surgery in low- and middle-income countries (LMICs). However, with the crescendo of cost-effectiveness analyses in global surgery has come vast disparities in methodology, with only 15% of studies adhering to published guidelines. This has led to results that have varied up to 150-fold. METHODS: The theoretical basis, common pitfalls, and guidelines-based recommendations for cost-effectiveness analyses are reviewed, and a checklist to be used for cost-effectiveness analyses in global surgery is created. RESULTS: Common pitfalls in global surgery cost-effectiveness analyses fall into five categories: the analytic perspective, cost measurement, effectiveness measurement, probability estimation, valuation of the counterfactual, and heterogeneity and uncertainty. These are reviewed in turn, and a checklist to avoid these pitfalls is developed. CONCLUSION: Cost-effectiveness analyses, when done rigorously, can be very useful for the development of efficient surgical systems in LMICs. This review highlights the common pitfalls in these analyses and methods to avoid these pitfalls.
Authors: Don Husereau; Michael Drummond; Stavros Petrou; Chris Carswell; David Moher; Dan Greenberg; Federico Augustovski; Andrew H Briggs; Josephine Mauskopf; Elizabeth Loder Journal: Value Health Date: 2013 Mar-Apr Impact factor: 5.725
Authors: Tiffany E Chao; Ketan Sharma; Morgan Mandigo; Lars Hagander; Stephen C Resch; Thomas G Weiser; John G Meara Journal: Lancet Glob Health Date: 2014-05-21 Impact factor: 26.763
Authors: Stephen Bickler; Doruk Ozgediz; Richard Gosselin; Thomas Weiser; David Spiegel; Renee Hsia; Peter Dunbar; Kelly McQueen; Dean Jamison Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Karin Lowson; Michelle Jenks; Alexandra Filby; Louise Carr; Bruce Campbell; John Powell Journal: Implement Sci Date: 2015-06-30 Impact factor: 7.327
Authors: Ava Yap; Arlene Muzira; Maija Cheung; James Healy; Nasser Kakembo; Phyllis Kisa; David Cunningham; George Youngson; John Sekabira; Reza Yaesoubi; Doruk Ozgediz Journal: Surgery Date: 2018-05-23 Impact factor: 3.982
Authors: Samar Sheriff; Hassan J Zawahrah; Lenisa V Chang; Sonay Beyatli; Haithem M Elhadi Babiker; Ashton L Roach; Natalyia Biskup; John A van Aalst Journal: World J Surg Date: 2018-05 Impact factor: 3.352
Authors: Emily R Smith; Tessa Concepcion; Stephanie Lim; Sam Sadler; Dan Poenaru; Anthony T Saxton; Mark Shrime; Emmanuel Ameh; Henry E Rice Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Ava Yap; Maija Cheung; Arlene Muzira; James Healy; Nasser Kakembo; Phyllis Kisa; David Cunningham; George Youngson; John Sekabira; Reza Yaesoubi; Doruk Ozgediz Journal: Ann Surg Date: 2021-02-01 Impact factor: 13.787
Authors: Dennis Cornelissen; Gerald Mwapasa; Jakub Gajewski; Tracey McCauley; Eric Borgstein; Ruairi Brugha; Leon Bijlmakers Journal: World J Surg Date: 2018-01 Impact factor: 3.352