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Cost-effectiveness analysis of pediatric cardiac surgery for common lesions in Rwanda
Vongai C Mlambo1, Yayehyirad Ejigu2, Kara L Neil2
1Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
Insights
Congenital heart defect surgery in Rwanda is highly cost-effective, offering significant life years for children. This vital intervention is affordable, even with increased complexity or costs.
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Pediatric Cardiology
Background:
- Sub-Saharan Africa has a critical shortage of pediatric cardiac surgery, with only 3% of children with congenital heart disease (CHD) receiving life-saving operations.
- Scaling up cardiac procedures is essential to address the unmet surgical needs in the region.
- Cost-utility analysis provides a framework for evaluating the economic impact of congenital heart surgery in low-resource settings.
Purpose of the Study:
- To conduct a cost-utility analysis comparing surgical intervention versus medical management for common CHDs in Rwanda.
- To determine the cost-effectiveness of pediatric cardiac surgery in a sub-Saharan African context.
Main Methods:
- A Markov model simulated surgical intervention and medical management for a mix of four common CHDs in Rwanda.
- Peri-operative complication risks were sourced from a local pediatric cardiac surgery program, and long-term outcomes from published studies.
- Micro-costing assessed program expenses, with health benefits measured in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were compared against Rwanda's GDP per capita.
Main Results:
- Surgical intervention yielded an additional 17.15 discounted QALYs at an extra cost of $6738.23, resulting in an ICER of $269.52/QALY.
- Even with increased surgical costs, the ICER remained below $580/QALY.
- Probabilistic sensitivity analysis demonstrated that surgery was cost-effective in 100% of simulations, including at a threshold of one-times GDP per capita.
Conclusions:
- Pediatric cardiac surgery for common CHDs in Rwanda is a highly cost-effective intervention.
- The long-term gains in life years significantly outweigh the initial surgical costs.
- Enhancing cost-effectiveness further can be achieved by managing more complex cases and reducing initial surgical expenses.
Background:
Only 3 % of children in sub-Saharan Africa with congenital heart disease (CHD) have access to life-saving surgery. There is an urgent need to scale up the volume of cardiac procedures. Cost-utility analysis can assess the health economic impacts of performing congenital heart surgery in this region.
Methods:
We performed a cost-utility analysis comparing surgical intervention and medical management for a weighted case mix of the four most common CHDs in Rwanda. A Markov model was constructed to simulate the course of each strategy. Probability of peri-operative complications was derived from the local pediatric cardiac surgery program and risks of long-term outcomes from large, published cohort studies. Micro-costing was used to calculate expenses from program cost data. Health benefits were measured in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analysis was performed. Incremental cost-effectiveness ratios (ICER) were compared to a willingness-to-pay threshold three times the GDP per capita of Rwanda (USD$2898·60).
Results:
Surgical intervention provided 17·15 additional discounted QALYs compared to medical management for an extra USD$6738·23. The ICER for surgical intervention was USD$269·52/QALY. Increasing the cost of surgery raised the ICER to a maximum of USD$580/QALY. In the probabilistic sensitivity analysis, surgery was cost-effective 100 % of the time including at one-times GDP per capita.
Conclusion:
Surgical intervention for common CHD in Rwanda is very cost-effective. The initial cost of surgery is compensated for by decades of additional life years. Increasing case complexity and decreasing the initial cost of surgery can make surgery even more cost-effective.
