Cleft lip and palate as a cost-effective health care treatment in the developing world

The considerable number of surgical procedures performed each year, as well as the significant burden of surgical disease globally, have brought surgery into the arena of public health concerns. Several articles have shown the cost-effectiveness of surgical interventions in the developing world. The authors suggest that surgery has an important role in global public health, specifically through international volunteer surgical missions as a vehicle for delivery.

Eight Operation Smile medical missions from 2008 are analyzed using the disability-adjusted life year (DALY) framework and disability weights from the life tables of the first Disease Control Priorities Project (DCP1). The DCP1 life tables suggest that the entire burden of disease from a cleft lip and palate is incurred within the first 4 years of life. The same group of missions is analyzed using life tables modified by the authors to reflect the disability associated with cleft lip and palate that goes beyond the first 5 years of life.

Using the DCP1 life tables, the cost per patient during the eight Operation Smile missions analyzed was $278 and $1827 with an average of $796. Using the life tables modified by the authors, the cost per patient was between $7.36 and $96.04 (average $33.94).

The absence of disability weights for untreated cleft lip and palate after the fifth year of life does not fit with the reality of living with an unrepaired cleft lip or palate. The authors conclude that secondary interventions alleviate disability and should enable an individual to approach a zero residual disability weight.