Punchak Maria, Lazareff Jorge A
Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Surg Neurol Int. 2017 Mar 14;8:37. doi: 10.4103/sni.sni_199_16. eCollection 2017.
Short-term surgical relief efforts have helped close some gaps in the provision of surgical care in remote settings. We reviewed the published literature on short-term surgical missions to compare their cost-effectiveness across subspecialties.
PubMed was searched using the algorithm ["cost-effectiveness" AND "surgery" AND ("mission" OR "volunteer")]. Articles detailing the cost-effectiveness of short-term surgical missions in low and middle-income countries (LMIC) were included. Only direct mission costs were considered, and all costs were converted into 2014 USD.
Eight articles, representing 27 missions in 9 LMIC countries during 2006-2014, met our inclusion criteria. Latin America was the most frequently visited region. Per capita costs ranged from $259 for cleft lip/cleft palate (CL/CP) missions to $2900 for a neurosurgery mission. Mission effectiveness ranged from 3 disability adjusted life years (DALYs) averted per patient for orthopedic surgery missions to 8.12 DALYs averted per patient for a neurosurgery mission. CL/CP and general surgery missions were the most cost-effective, averaging $80/DALY and $87/DALY, respectively. The neurosurgical, orthopedic, and hand surgery missions averaged the highest costs/DALY averted, with the cost-effectiveness being $357/DALY, $435/DALY, and $445/DALY, respectively. All analyzed missions were very cost effective.
To date, this is the first study to assess the cost-effectiveness of short-term surgical missions across surgical specialties. Neurosurgical missions avert the largest number of healthy life years compared to other specialties, and thus, could yield a greater long-term benefit to resource-poor communities. We recommend that further studies be carried out to assess the impact of surgical missions in low-resource settings.
短期外科救援行动有助于缩小偏远地区外科护理服务方面的一些差距。我们回顾了关于短期外科任务的已发表文献，以比较各亚专业的成本效益。
使用算法["成本效益" AND "外科手术" AND ("任务" OR "志愿者")]在PubMed上进行检索。纳入了详细介绍低收入和中等收入国家（LMIC）短期外科任务成本效益的文章。仅考虑直接任务成本，所有成本均换算为2014年美元。
8篇文章符合我们的纳入标准，这些文章代表了2006 - 2014年期间9个LMIC国家的27次任务。拉丁美洲是访问最频繁的地区。人均成本从唇腭裂（CL/CP）任务的259美元到神经外科任务的2900美元不等。任务效果从骨科手术任务每位患者避免3个伤残调整生命年（DALYs）到神经外科任务每位患者避免8.12个DALYs不等。CL/CP和普通外科任务成本效益最高，分别平均为80美元/DALY和87美元/DALY。神经外科、骨科和手外科任务避免每个DALY的平均成本最高，成本效益分别为357美元/DALY、435美元/DALY和445美元/DALY。所有分析的任务成本效益都非常高。
迄今为止，这是第一项评估各外科专业短期外科任务成本效益的研究。与其他专业相比，神经外科任务避免的健康生命年数最多，因此，可能为资源匮乏社区带来更大的长期益处。我们建议开展进一步研究，以评估外科任务在资源匮乏地区的影响。
