Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21210, USA.
World J Surg. 2012 Dec;36(12):2819-30. doi: 10.1007/s00268-012-1761-3.
Although surgery provided by international volunteers is increasingly common in the developing world, there have been few assessments of the cost-effectiveness of these activities. In this context, this study covered 15 years of experience of one international nongovernmental organization, Smile for Children, in providing cleft lip (CL) and cleft palate (CP) surgical services in Vietnam.
We analyzed the cost-effectiveness of the program and its contributions to building local capacity. To assess the cost-effectiveness of CL/CP surgery performed during Smile for Children's missions in Vietnam, we analyzed the data from four annual missions, from 2007 to 2010. According to the 2003 World Health Organization Guide to Cost-Effectiveness Analysis, we calculated cost per disability-adjusted life years (DALYs) averted with and without age weighting. For the data from the 2010 mission, we repeated the same calculation but with and without considering opportunity cost for labor.
The discounted cost per DALY averted averaged $68, ranging from $52 to $79 depending on the year of the mission. The average discounted cost per DALY averted with age weighting was $56 (range $43-$65). For the calculation that takes into account the volunteers' possible income loss as the labor cost of the mission in 2010, the cost per DALY averted without age weighting increased by 28%, from $76 to $97; and the cost per DALY averted with age weighting increased by 27%, from $63 to $80. Under all of these varying assumptions, the CL/CP program operated by Smile for Children is a cost-effective intervention using international criteria for cost-effectiveness.
The contribution of the international volunteer surgical team to building in-country capacity is notable. It was achieved primarily through training Vietnamese surgeons during the mission trips and through sending these surgeons to Korea for training. Other staff, including anesthesiologists, were also trained; and equipment and supplies were provided.
尽管发展中国家越来越多地接受国际志愿者提供的外科手术，但对这些活动的成本效益评估却很少。在这种情况下，本研究涵盖了国际非政府组织“儿童微笑”（Smile for Children）在越南提供唇裂（CL）和腭裂（CP）外科服务 15 年的经验。
我们分析了该项目的成本效益及其对建立当地能力的贡献。为了评估 Smile for Children 在越南开展的 CL/CP 手术的成本效益，我们分析了 2007 年至 2010 年四次年度任务的数据。根据 2003 年世界卫生组织成本效益分析指南，我们计算了不考虑年龄加权和考虑年龄加权时每避免一个残疾调整生命年（DALY）的成本。对于 2010 年任务的数据，我们重复了同样的计算，但考虑了和不考虑劳动力的机会成本。
避免一个残疾调整生命年（DALY）的已贴现成本平均为 68 美元，根据任务的年份，范围从 52 美元到 79 美元不等。考虑年龄加权时，每避免一个残疾调整生命年（DALY）的平均已贴现成本为 56 美元（范围为 43-65 美元）。对于考虑到 2010 年任务中志愿者可能的收入损失作为劳动力成本的计算，不考虑年龄加权的情况下，每避免一个残疾调整生命年（DALY）的成本增加了 28%，从 76 美元增加到 97 美元；考虑年龄加权时，每避免一个残疾调整生命年（DALY）的成本增加了 27%，从 63 美元增加到 80 美元。在所有这些不同的假设下，根据国际成本效益标准，Smile for Children 开展的 CL/CP 项目是一种具有成本效益的干预措施。
国际志愿外科医疗队对建立国内能力的贡献是显著的。这主要是通过在任务期间培训越南外科医生，并将这些外科医生送往韩国进行培训来实现的。还培训了其他工作人员，包括麻醉师，并提供了设备和用品。
