Economic analysis of children's surgical care in low- and middle-income countries: A systematic review and analysis

Anthony T. Saxton, Dan Poenaru, Doruk Ozgediz, Emmanuel A. Ameh, Diana L Farmer, Emily R. Smith, Henry E. Rice

Research output: Contribution to journalArticle

29 Citations (Scopus)

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 costeffectiveness 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. Findings 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. Interpretation 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.

Original languageEnglish (US)
Article numbere0165480
JournalPLoS One
Volume11
Issue number10
DOIs
StatePublished - Oct 1 2016

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Economic analysis
systematic review
Child Care
economic analysis
economic valuation
disability-adjusted life year
income
hernia
surgery
Economics
disability weights
economics
Repair
palate
orthopedics
resource allocation
lips
economic impact
Quality-Adjusted Life Years
Inguinal Hernia

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Economic analysis of children's surgical care in low- and middle-income countries : A systematic review and analysis. / Saxton, Anthony T.; Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A.; Farmer, Diana L; Smith, Emily R.; Rice, Henry E.

In: PLoS One, Vol. 11, No. 10, e0165480, 01.10.2016.

Research output: Contribution to journalArticle

Saxton, Anthony T. ; Poenaru, Dan ; Ozgediz, Doruk ; Ameh, Emmanuel A. ; Farmer, Diana L ; Smith, Emily R. ; Rice, Henry E. / Economic analysis of children's surgical care in low- and middle-income countries : A systematic review and analysis. In: PLoS One. 2016 ; Vol. 11, No. 10.
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