运用福利损失价值法对一家大型外科慈善机构的影响进行经济评估。
Economic valuation of the impact of a large surgical charity using the value of lost welfare approach.
作者信息
Corlew Daniel Scott, Alkire Blake C, Poenaru Dan, Meara John G, Shrime Mark G
机构信息
Murfreesboro, Tennessee, USA.
Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
出版信息
BMJ Glob Health. 2016 Dec 8;1(4):e000059. doi: 10.1136/bmjgh-2016-000059. eCollection 2016.
BACKGROUND
The assessment of the economic burden of surgical disease is integral to determining allocation of resources for health globally. We estimate the economic gain realised over an 11-year period resulting from a vertical surgical programme addressing cleft lip (CL) and cleft palate (CP).
METHODS
The database from a large non-governmental organisation (Smile Train) over an 11-year period was analysed. Incidence-based disability-adjusted life years (DALYs) averted through the programme were calculated, discounted 3%, using disability weights from the Global Burden of Disease (GBD) study and an effectiveness factor for each surgical intervention. The effectiveness factor allowed for the lack of 100% resolution of the disability from the operation. We used the value of lost welfare approach, based on the concept of the value of a statistical life (VSL), to assess the economic gain associated with each operation. Using income elasticities (IEs) tailored to the income level of each country, a country-specific VSL was calculated and the VSL-year (VSLY) was determined. The VSLY is the economic value of a DALY, and the DALYs averted were converted to economic gain per patient and aggregated to give a total value and an average per patient. Sensitivity analyses were performed based on the variations of IE applied for each country.
RESULTS
Each CL operation averted 2.2 DALYs on average and each CP operation 3.3. Total averted DALYs were 1 325 678 (CP 686 577 and CL 639 102). The economic benefit from the programme was between US$7.9 and US$20.7 billion. Per patient, the average benefit was between US$16 133 and US$42 351. Expense per DALY averted was estimated to be $149.
CONCLUSIONS
Addressing basic surgical needs in developing countries provides a massive economic boost through improved health. Expansion of surgical capacity in the developing world is of significant economic and health value and should be a priority in global health efforts.
背景
评估外科疾病的经济负担对于确定全球卫生资源的分配至关重要。我们估算了一项针对唇裂（CL）和腭裂（CP）的垂直外科手术计划在11年期间所实现的经济收益。
方法
分析了一个大型非政府组织（微笑列车）11年期间的数据库。使用全球疾病负担（GBD）研究中的残疾权重和每项外科手术的有效性因子，计算该计划避免的基于发病率的残疾调整生命年（DALYs），并按3%进行贴现。有效性因子考虑到手术无法使残疾得到100%解决的情况。我们采用基于统计生命价值（VSL）概念的福利损失价值法，来评估每项手术相关的经济收益。利用根据每个国家收入水平定制的收入弹性（IEs），计算特定国家的VSL，并确定VSL年（VSLY）。VSLY是一个DALY的经济价值，避免的DALYs被转换为每位患者的经济收益，并汇总得出总价值和每位患者的平均值。基于每个国家应用的IE变化进行敏感性分析。
结果
每项唇裂手术平均避免2.2个DALYs，每项腭裂手术平均避免3.3个。总共避免的DALYs为1325678个（腭裂686577个，唇裂639102个）。该计划的经济效益在79亿美元至207亿美元之间。每位患者的平均收益在16133美元至42351美元之间。估计避免每个DALY的费用为149美元。
结论
满足发展中国家的基本外科需求可通过改善健康带来巨大的经济推动。扩大发展中世界的外科手术能力具有重大的经济和健康价值，应成为全球卫生工作的优先事项。
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