Disability Weights for Pediatric Surgical Procedures: A Systematic Review and Analysis

Area of Science:

• Global Health
• Pediatric Surgery
• Health Economics

Background:

• Disability weights (DWs) are crucial for measuring the burden of disease, but are poorly defined for pediatric surgical conditions.
• Accurate metrics are needed to assess the cost-effectiveness and impact of pediatric surgical interventions in low- and middle-income countries (LMICs).

Purpose of the Study:

• To systematically review existing disability weights (DWs) for pediatric surgical conditions in LMICs.
• To evaluate the adequacy of current DWs for quantifying the burden of pediatric surgical disease.

Main Methods:

• Systematic literature search of MEDLINE for pediatric surgery cost-effectiveness studies in LMICs (1996-2017).
• Inclusion of DWs from Global Burden of Disease studies, bibliographies, and expert opinion.
• Analysis of 194 discrete DWs for 66 pediatric surgical conditions.

Main Results:

• The Global Burden of Disease studies were the primary source of DWs (72%).
• Only a small fraction of reported DWs reflected pre- (12) or post-surgical (12) severity.
• Significant variation in methodological quality was observed among included studies and DWs.

Conclusions:

• Existing disability weights are insufficient for accurately quantifying the burden of pediatric surgical conditions.
• Development of a comprehensive set of DWs is needed, considering pediatric-specific factors and disease severity.
• Improved metrics are essential for informed policy decisions regarding pediatric surgical care in LMICs.