Cost Effectiveness Analysis: Small Country Pediatric Cardiac Surgery Program Development

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Published: Jun 24, 2022
DOI: https://doi.org/10.12681/jhcvm.30093
Keywords:
Pediatric Cardiac Surgery Humanitarian Surgery Cost-Effectiveness analysis, Outsourcing Healthcare
Marcelo Cardarelli
Inova Children Hospital
https://orcid.org/0000-0002-1105-4878
Vladimir Chadikovski
Acibadem Sistina Hospital, Skopje, North Macedonia
William Novick
Abstract

Abstract


 


Background


The cost-effectiveness of sending children abroad for treatment of their congenital heart disease (CHD) in small population countries versus developing a local program should be carefully considered. We investigated the cost-effectiveness analysis of developing such program in a small Eastern-European country.


Methods


Calculated costs during different stages in the development of a program in North Macedonia were obtained from the Ministry of Health. All patients diagnosed and surgically treated between 2010 and 2017 were included along 3 distinctive periods.


2010-2012 - Outsourcing (All patients sent abroad for surgical treatment)


2013-2016 - Foundational (Program development with assistance from a global charity organization)


2017 - Tutelage Period (Semi-Independent program)


Cost-Effectiveness is provided in US$ per Disability Adjusted Life Years (DALY) as unit of health value.


Results


Between January 2010 and December 2017, a total of 384 patients diagnosed with CHD underwent surgical treatment at government expense. The breakdown was: 125; 204 and 55 patients in each period.The cost-effectiveness of the intervention was $315; $297 and $251 per DALY averted respectively.


Conclusions


Surgical treatment of patients born with CHD is a highly cost-effective intervention irrespective of the approach taken. Even after accounting for the initial capital investment costs, the development of a local pediatric cardiac surgery program seems to be slightly more cost-effective than outsourcing.


 

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References
J I. E. Hoffman, S Kaplan. The Incidence of Congenital Heart Disease J Am Coll Cardiol 2002;39:1890 -900
UNICEF data, (http://www.theworldcounts.com/stories/HowMany-Babies-Are-Born-Each-Day) Accessed September 09, 2018
Pezzella AT. International cardiac surgery: a global perspective. Semin Thorac Cardiovasc Surg 2002;14(04):298-320
Saxena A. Strategies for the improvement of cardiac care services in developing countries: what does the future hold? Future Cardiol 2012;8(01):29-38
Hoffman JIE. The global burden of congenital heart disease. Cardiovasc J Afr 2013;24(04):141-145
M. Cardarelli, S. Vaikunth, K. Mills; et al.Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery Programs in Lowand Middle Income Countries. JAMA Open Network - November 16, 2018. doi:10.1001/jamanetworkopen.2018.4707
J Perrot. Different approaches to contracting in health systems. Bulletin of the World Health Organization | November 2006, 84 (11)
A R Vining, S. Globerman., Contracting-out health care services: a conceptual framework Health Policy 46 (1999) 77-96
Odendaal WA1, Ward K, Uneke J, et al. Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries. Cochrane Database Syst Rev. 2018 Apr 3;4:CD008133. doi: 10.1002/14651858. CD008133.pub2.
Vong S, Raven J, Newlands D., Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting. BMC Health Serv Res. 2018 May 22;18(1):375. doi: 10.1186/s12913-018-3165-z.
N. Palmer, L. Strong, A. Wali, et al. Contracting out health services in fragile states BMJ. Health policy 2006 Mar 25; 332(7543): 718-721. doi:10.1136/bmj.332.7543.718
I. A.Glinosa, R. Baetenb, H.Maarsea., Purchasing health services abroad: Practices of cross-border contracting and patient mobility in six European countries Health Policy Vol 95, Issues 2-3; 103-112May 2010,
Ashton T., The benefits and risks of DHBs contracting out elective procedures to private providers. N Z Med J. 2010 May 14;123(1314):84-91.
K Grumbach, G. M. Anderson, H. S. Luft,; et al., Regionalization of Cardiac Surgery in the United States and Canada Geographic Access, Choice, and Outcomes. JAMA. 1995;274(16):1282- 1288. doi:10.1001/jama.1995.03530160034030 October 25, 1995
S. J. Katz,H. F. Mizgala, et al. British Columbia Sends Patients to Seattle for Coronary Artery Surgery Bypassing the Queue in Canada. JAMA. 1991;266(8):1108-1111. doi:10.1001/ jama.1991.03470080078033 August 28, 1991
Tanzil S, Zahidie A, Ahsan A, Kazi A,. A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform? BMC Health Serv Res. 2014 Jun 25;14:277. doi: 10.1186/1472-6963-14-277.
Liu X, Hotchkiss DR, Bose S., The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence. Health Policy Plan. 2008 Jan;23(1):1- 13. Epub 2007 Nov 13. Review.
Barendregt JJ, Bonneux L, Van der Maas PJ. DALYs: the ageweights on balance. Bull World Health Organ 1996;74(4):439- 443.
Arnesen T, Nord E. The value of DALY life: problems with ethics and validity of disability- adjusted life years. BMJ. 1999;319(7222):1423-1425. doi:10.1136/bmj.319.7222.1423
Torgerson DJ, Raftery J. Economic notes: discounting. BMJ. 1999;319 (7214):914-915. doi:10.1136/bmj.319.7214.914
H-G Eichler, S. X. Kong, W. C. Gerth., Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge? Value in Health Vol 7 • Number 5 , 2004
Choosing Interventions that are Cost Effective. WHOCHOICE. (https://www.who.int/choice/en) Accessed July 12, 2018
E A Halm, C Halm, MR Chassin., Is Volume Related to Outcomes in Health Care? A Systematic Review and Methodologic Critique of the Literature. Ann Intern Med 2002;137:511-520
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