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Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

Publication ,  Journal Article
Saxton, AT; Poenaru, D; Ozgediz, D; Ameh, EA; Farmer, D; Smith, ER; Rice, HE
Published in: PLoS One
2016

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. 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.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2016

Volume

11

Issue

10

Start / End Page

e0165480

Location

United States

Related Subject Headings

  • Surgical Procedures, Operative
  • Humans
  • General Science & Technology
  • Disability Evaluation
  • Developing Countries
  • Cost-Benefit Analysis
  • Child
 

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Saxton, A. T., Poenaru, D., Ozgediz, D., Ameh, E. A., Farmer, D., Smith, E. R., & Rice, H. E. (2016). Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One, 11(10), e0165480. https://doi.org/10.1371/journal.pone.0165480
Saxton, Anthony T., Dan Poenaru, Doruk Ozgediz, Emmanuel A. Ameh, Diana Farmer, Emily R. Smith, and Henry E. Rice. “Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.PLoS One 11, no. 10 (2016): e0165480. https://doi.org/10.1371/journal.pone.0165480.
Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, et al. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One. 2016;11(10):e0165480.
Saxton, Anthony T., et al. “Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.PLoS One, vol. 11, no. 10, 2016, p. e0165480. Pubmed, doi:10.1371/journal.pone.0165480.
Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, Rice HE. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One. 2016;11(10):e0165480.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2016

Volume

11

Issue

10

Start / End Page

e0165480

Location

United States

Related Subject Headings

  • Surgical Procedures, Operative
  • Humans
  • General Science & Technology
  • Disability Evaluation
  • Developing Countries
  • Cost-Benefit Analysis
  • Child