The impact and cost-effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Repair Programme in Eastern and Central Africa.

Hasan Hamze,Asrat Mengiste,Jane Carter

doi:10.11604/pamj.2017.28.35.10344

Abstract

IntroductionCleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006.MethodsWe analyzed anonymized data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods.ResultsThe median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods.ConclusionCleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits.

Highlights

Cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries
Surgical correction of CLP resulted in a total of 122,359-207,879 averted Disability-Adjusted Life Years (DALYs), depending on age-weighting and discounting parameters
The sensitivity analysis carried out for averted DALYs per procedure was used to calculate the cost per DALY, resulting in $62.76$106.62 for CLP repair

Summary

Introduction

Cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Methods: We analyzed anonymized data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods. Correcting CLP through surgery is relatively straightforward, specialized surgical expertise and good post-operative facilities are required to avoid potentially lethal complications of surgery This has created a significant surgical backlog in many low- and middle-income countries (LMICs) where expertise and infrastructure may not be readily available [3]. Large numbers of children with CLP remain untreated for many years in LMICs, some into adulthood

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