Grimes Caris E, Holmer Hampus, Maraka Jane, Ayana Birhanu, Hansen Linda, Lavy Christopher B D
Kings Centre for Global Health and Kings Health Partners, Kings College London, London, UK.
Department of Clinical Sciences, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden.
BMJ Glob Health. 2016 May 26;1(1):e000023. doi: 10.1136/bmjgh-2015-000023. eCollection 2016.
Club foot is a common congenital deformity affecting 150 000-200 000 children every year. Untreated patients end up walking on the side or back of the affected foot, with severe social and economic consequences. Club foot is highly treatable by the Ponseti method, a non-invasive technique that has been described as highly suitable for use in resource-limited settings. To date, there has been no evaluation of its cost-effectiveness ratio, defined as the cost of averting one disability-adjusted life year (DALY), a composite measure of the impact of premature death and disability. In this study, we aimed to calculate the average cost-effectiveness ratio of the Ponseti method for correcting club foot in sub-Saharan Africa.
Using data from 12 sub-Saharan African countries provided by the international non-profit organisation CURE Clubfoot, which implements several Ponseti treatment programmes around the world, we estimated the average cost of the point-of-care treatment for club foot in these countries. We divided the cost of treatment with the average number of DALYs that can be averted by the Ponseti treatment, assuming treatment is successful in 90% of patients.
We found the average cost of the Ponseti treatment to be US$167 per patient. The average number of DALYs averted was 7.42, yielding a cost-effectiveness ratio of US$22.46 per DALY averted. To test the robustness of our calculation different variables were used and these yielded a cost range of US$5.28-29.75. This is less than a tenth of the cost of many other treatment modalities used in resource-poor settings today.
The Ponseti method for the treatment of club foot is cost-effective and practical in a low-income country setting. These findings could be used to raise the priority for implementing Ponseti treatment in areas where patients are still lacking access to the life-changing intervention.
马蹄内翻足是一种常见的先天性畸形，每年影响15万至20万名儿童。未经治疗的患者最终会用患足的外侧或后侧行走，会造成严重的社会和经济后果。马蹄内翻足通过庞塞蒂方法可得到有效治疗，这是一种非侵入性技术，已被描述为非常适合在资源有限的环境中使用。迄今为止，尚未对其成本效益比进行评估，成本效益比的定义为避免一个伤残调整生命年（DALY）的成本，DALY是对过早死亡和残疾影响的综合衡量指标。在本研究中，我们旨在计算庞塞蒂方法在撒哈拉以南非洲矫正马蹄内翻足的平均成本效益比。
利用国际非营利组织“治愈马蹄内翻足”提供的来自撒哈拉以南非洲12个国家的数据，该组织在全球实施了多个庞塞蒂治疗项目，我们估算了这些国家马蹄内翻足即时治疗的平均成本。我们将治疗成本除以庞塞蒂治疗可避免的DALY平均数量，假设90%的患者治疗成功。
我们发现庞塞蒂治疗的平均成本为每位患者167美元。避免的DALY平均数量为7.42，得出的成本效益比为每避免一个DALY 22.46美元。为检验我们计算的稳健性，使用了不同变量，得出的成本范围为5.28美元至29.75美元。这不到当今资源匮乏地区使用的许多其他治疗方式成本的十分之一。
庞塞蒂方法治疗马蹄内翻足在低收入国家环境中具有成本效益且切实可行。这些发现可用于提高在患者仍无法获得这种改变生活的干预措施的地区实施庞塞蒂治疗的优先级。
