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

Authors: Blake Alkire, Jeffrey R. Vincent, John Meara


Since surgery was first included in the second edition of Disease Control Priorities (DCP2), 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 with the growing body of evidence that surgical platforms can be cost-effective in LMICs, a nascent field of study within global health economics has attempted to expand the use of benefit-cost analysis (BCA) to global health interventions in LMICs. In contrast with cost-effectiveness analysis (CEA), BCA attempts to estimate the 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 make meaningful comparisons of 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, Dean Jamison and others prominently featured BCA in their challenge papers for the 2008 and 2012 Copenhagen Consensus (Jamison, Jha, and Bloom 2008; Jamison and others 2012).

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 chapter 8 of this volume. This chapter presents an approach for performing BCA using CLP repair as a model surgical intervention in a subspecialty hospital dedicated to CLP in India.

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