Modeling the Scale-up of Surgical Services for Children with Surgically Treatable Congenital Conditions in Somaliland
Vivian S Vigliotti1, Tessa Concepcion2, Mubarak Mohamed3
1Yale New Haven Health, New Haven, CT, USA.
Insights
Scaling up surgical care for children
Area of Science:
- Global child surgery
- Congenital anomalies
- Public health economics
Background:
- Congenital conditions represent a major global burden of surgical disease in children.
- Somaliland faces a critical gap, with over 250,000 children annually lacking necessary surgical care.
- The economic implications of expanding pediatric surgical services in Somaliland remain unquantified.
Purpose of the Study:
- To evaluate the cost-effectiveness of scaling up surgical services for children in Somaliland.
- To project the costs and benefits associated with different rates of surgical care expansion.
- To determine the net societal monetary benefit of addressing the surgical burden of congenital anomalies.
Main Methods:
- A Markov model integrated with a decision tree template was employed.
- Cost-effectiveness and net societal monetary benefit were projected over a 10-year horizon.
- A proxy set of congenital anomalies and existing disability weights informed the analysis.
Main Results:
- Aggressive scale-up (22.5% rate) of pediatric surgical services is cost-effective.
- Most congenital anomalies demonstrated cost-effective surgical care scale-up.
- Hydrocephalus and spina bifida interventions showed lower cost-effectiveness compared to other conditions.
Conclusions:
- Scaling up surgical services for congenital anomalies in children in Somaliland is a cost-effective strategy.
- Investment in pediatric surgical care expansion is recommended to address the significant disease burden.
- Targeted approaches may be necessary for conditions like hydrocephalus and spina bifida.
Background:
Congenital conditions comprise a significant portion of the global burden of surgical conditions in children. In Somaliland, over 250,000 children do not receive required surgical care annually, although the estimated costs and benefits of scale-up of children's surgical services to address this disease burden is not known.
Methods:
We developed a Markov model using a decision tree template to project the costs and benefits of scale-up of surgical care for children across Somaliland. We used a proxy set of congenital anomalies across Somaliland to estimate scale-up costs using three different scale-up rates. The cost-effectiveness ratio and net societal monetary benefit were estimated using these models, supported by disability weights in existing literature.
Results:
Overall, we found that scale-up of surgical services at an aggressive rate (22.5%) over a 10-year time horizon is cost effective. Although the scale-up of surgical care for most conditions in the proxy set was cost effective, scale-up of hydrocephalus and spina bifida are not as cost effective as other conditions.
Conclusions:
Our analysis concludes that it is cost effective to scale-up surgical services for congenital anomalies for children in Somaliland.
