Warf Benjamin C, Alkire Blake C, Bhai Salman, Hughes Christopher, Schiff Steven J, Vincent Jeffrey R, Meara John G
Department of Neurosurgery, Children’s Hospital Boston, Boston, MA, USA.
J Neurosurg Pediatr. 2011 Nov;8(5):509-21. doi: 10.3171/2011.8.PEDS11163.
Evidence from the CURE Children's Hospital of Uganda (CCHU) suggests that treatment for hydrocephalus in infants can be effective and sustainable in a developing country. This model has not been broadly supported or implemented due in part to the absence of data on the economic burden of disease or any assessment of the cost and benefit of treatment. The authors used economic modeling to estimate the annual cost and benefit of treating hydrocephalus in infants at CCHU. These results were then extrapolated to the potential economic impact of treating all cases of hydrocephalus in infants in sub-Saharan Africa (SSA).
The authors conducted a retrospective review of all children initially treated for hydrocephalus at CCHU via endoscopic third ventriculostomy or shunt placement in 2005. A combination of data and explicit assumptions was used to determine the number of times each procedure was performed, the cost of performing each procedure, the number of disability-adjusted life years (DALYs) averted with neurosurgical intervention, and the economic benefit of the treatment. For CCHU and SSA, the cost per DALY averted and the benefit-cost ratio of 1 year's treatment of hydrocephalus in infants were determined.
In 2005, 297 patients (median age 4 months) were treated at CCHU. The total cost of neurosurgical intervention was $350,410, and the cost per DALY averted ranged from $59 to $126. The CCHU's economic benefit to Uganda was estimated to be between $3.1 million and $5.2 million using a human capital approach and $4.6 million-$188 million using a value of a statistical life (VSL) approach. The total economic benefit of treating the conservatively estimated 82,000 annual cases of hydrocephalus in infants in SSA ranged from $930 million to $1.6 billion using a human capital approach and $1.4 billion-$56 billion using a VSL approach. The minimum benefit-cost ratio of treating hydrocephalus in infants was estimated to be 7:1.
Untreated hydrocephalus in infants exacts an enormous price from SSA. The results of this study suggest that neurosurgical intervention has a cost/DALY averted comparable to other surgical interventions that have been evaluated, as well as a favorable benefit-cost ratio. The prevention and treatment of hydrocephalus in SSA should be recognized as a major public health priority.
乌干达库雷儿童医院（CCHU）的证据表明，在发展中国家，婴儿脑积水的治疗可以有效且可持续。该模式尚未得到广泛支持或实施，部分原因是缺乏疾病经济负担数据或对治疗成本效益的任何评估。作者使用经济模型来估计CCHU治疗婴儿脑积水的年度成本和效益。然后将这些结果外推至撒哈拉以南非洲（SSA）治疗所有婴儿脑积水病例的潜在经济影响。
作者对2005年在CCHU最初通过内镜下第三脑室造瘘术或分流术治疗脑积水的所有儿童进行了回顾性研究。结合数据和明确假设来确定每种手术的执行次数、每次手术的成本、神经外科干预避免的残疾调整生命年（DALY）数量以及治疗的经济效益。对于CCHU和SSA，确定了避免每DALY的成本以及婴儿脑积水1年治疗的效益成本比。
2005年，CCHU治疗了297例患者（中位年龄4个月）。神经外科干预的总成本为350,410美元，避免每DALY的成本在59美元至126美元之间。使用人力资本方法，CCHU对乌干达的经济效益估计在310万美元至520万美元之间；使用统计生命价值（VSL）方法，估计为460万美元至1.88亿美元。使用人力资本方法，保守估计SSA每年82,000例婴儿脑积水病例的治疗总经济效益在9.3亿美元至16亿美元之间；使用VSL方法，估计为14亿美元至560亿美元。婴儿脑积水治疗的最低效益成本比估计为7:1。
SSA中未经治疗的婴儿脑积水造成了巨大代价。本研究结果表明，神经外科干预避免每DALY的成本与其他已评估的外科干预相当，且效益成本比良好。SSA中脑积水的预防和治疗应被视为主要的公共卫生重点。
