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

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

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 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.

Suggested Citation

  • Anthony T Saxton & Dan Poenaru & Doruk Ozgediz & Emmanuel A Ameh & Diana Farmer & Emily R Smith & Henry E Rice, 2016. "Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-20, October.
    • Handle: RePEc:plo:pone00:0165480
    DOI: 10.1371/journal.pone.0165480
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    References listed on IDEAS

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    5. Agnes Binagwaho & Elisabetta Pegurri & Jane Muita & Stefano Bertozzi, 2010. "Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study," PLOS Medicine, Public Library of Science, vol. 7(1), pages 1-10, January.
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    Cited by:

    1. Emily R Smith & Tessa L Concepcion & Mubarak Mohamed & Shugri Dahir & Edna Adan Ismail & Henry E Rice & Anirudh Krishna & on behalf of the Global Initiative for Children’s Surgery, 2019. "The contribution of pediatric surgery to poverty trajectories in Somaliland," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-16, July.
    2. Gursharan K. Sohi & Jordan Levy & Victoria Delibasic & Laura E. Davis & Alyson L. Mahar & Elmira Amirazodi & Craig C. Earle & Julie Hallet & Ahmed Hammad & Rajan Shah & Nicole Mittmann & Natalie G. Co, 2021. "The cost of chemotherapy administration: a systematic review and meta-analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(4), pages 605-620, June.

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