Benefit-Cost Analysis for Selected Surgical Interventions in Low- and Middle-Income Countries

Excerpt

Since surgery was first included in the second edition of Disease Control Priorities (DCP2, 2006), research examining the cost-effectiveness of surgical interventions in low- and middle-income countries (LMICs) has expanded substantially (see chapter 18). A growing body of evidence suggests that surgical platforms can be cost-effective in these countries, according to the criteria established by the World Health Organization (WHO) (Grimes and others 2013).

In parallel, a nascent field of study within global health economics has attempted to expand the application of benefit-cost analysis (BCA) to global health interventions in these countries. In contrast with cost-effectiveness analysis, BCA seeks to estimate the net economic benefit of an intervention in monetary terms. The nature of BCA allows researchers to investigate the potential economic return of an investment in global health; it also allows ministries of health and finance to meaningfully compare health care projects to investments in other governmental sectors, such as education and transportation, which are routinely valued with BCA. The use of BCA in global health has recently become more visible; for example, Jamison, Jha, and Bloom (2008) and Jamison and others (2012) prominently feature BCA in their challenge papers for the 2008 and 2012 Copenhagen Consensus (CC).

Within the surgical cost-effectiveness literature, cleft lip and palate (CLP) has been the subject of at least three cost-effectiveness studies in LMICs; all suggest that CLP can be repaired in LMICs in a cost-effective manner (Corlew 2010; Magee, Vander Burg, and Hatcher 2010; Poenaru 2013). A more thorough review of CLP can be found in chapters 8 and 13 of this volume. The role of cesarean delivery in the context of obstructed labor, and its associated cost and benefit, has been previously studied by the authors (Alkire and others 2012a) and is presented here with updated results. This chapter presents two distinct BCAs:

1. An approach for performing BCA using CLP repair as a model surgical intervention using primary data from a subspecialty hospital dedicated to CLP in India

2. A BCA based on secondary data that model the benefit and cost of cesarean delivery for treatment of obstructed labor in 47 LMICs.