Background The assessment of the economic burden of surgical disease is integral to determining allocation of resources for health globally. We estimate the economic gain realised over an 11-year period resulting from a vertical surgical programme addressing cleft lip (CL) and cleft palate (CP).
Methods The database from a large non-governmental organisation (Smile Train) over an 11-year period was analysed. Incidence-based disability-adjusted life years (DALYs) averted through the programme were calculated, discounted 3%, using disability weights from the Global Burden of Disease (GBD) study and an effectiveness factor for each surgical intervention. The effectiveness factor allowed for the lack of 100% resolution of the disability from the operation. We used the value of lost welfare approach, based on the concept of the value of a statistical life (VSL), to assess the economic gain associated with each operation. Using income elasticities (IEs) tailored to the income level of each country, a country-specific VSL was calculated and the VSL-year (VSLY) was determined. The VSLY is the economic value of a DALY, and the DALYs averted were converted to economic gain per patient and aggregated to give a total value and an average per patient. Sensitivity analyses were performed based on the variations of IE applied for each country.
Results Each CL operation averted 2.2 DALYs on average and each CP operation 3.3. Total averted DALYs were 1 325 678 (CP 686 577 and CL 639 102). The economic benefit from the programme was between US$7.9 and US$20.7 billion. Per patient, the average benefit was between US$16 133 and US$42 351. Expense per DALY averted was estimated to be $149.
Conclusions Addressing basic surgical needs in developing countries provides a massive economic boost through improved health. Expansion of surgical capacity in the developing world is of significant economic and health value and should be a priority in global health efforts.
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Handling editor Seye Abimbola.
Contributors DSC originally conceived the study, coordinated the collaboration, did the mathematical data analysis, wrote the initial outline of the manuscript and managed the review process and completion. BCA was instrumental in the design of the study and the concept of using the value of lost welfare (VLW) and value of a statistical life (VSL) economic analysis, provided the expertise for that methodology with MGS, worked with the mathematical data analysis, worked extensively on the manuscript, wrote most of the Methods section, and performed a final review of the manuscript. DP originally conceived the study with DSC, worked extensively on the manuscript with multiple revisions, was instrumental in bringing the project to fruition and performed a final review of the manuscript. JGM assembled the collaborators, was instrumental in the concept of the economic analysis used, worked extensively on multiple revisions of the manuscript and performed a final review of the manuscript. MGS was instrumental in the design of the study and the use of VLW and VSL methodology, worked extensively on the manuscript with multiple revisions, helped provide clarity to its role in the literature, and performed a final review of the manuscript.
Funding The Smile Train funded the publication fee only.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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