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Economic Valuation and Disability Averted After Cleft Lip and/or Palate Repair in Botswana From 2018 to 2022
Isabel A Ryan1, Allison C Hu1, Mattia A Mahmoud1
1Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Background:
Little is known about access to surgical care for patients with cleft lip and/or palate (CL/P) in Botswana, nor have the effects on both the patient and the societal level been quantified. This study aims to assess the impact of CL/P repair on patient disability and economic productivity over a 5-year period in Botswana.
Methods:
A retrospective review of on-site surgical logbooks was used to identify all primary CL/P procedures from 2018 to 2022 across 6 geographically diverse hospitals throughout Botswana. Demographic and procedure-level data were collected. Disability-adjusted life years (DALYs) were calculated for each patient using Global Burden of Disease (GBD) reported disability weights and Botswana-specific life expectancy by sex, as well as estimates of residual disability. Averted DALYs and Botswana's GNI per capita (Atlas and Purchasing Power Parity) were used to determine the economic gains achieved over this 5-year period.
Results:
Eighty primary CL/P procedures were performed from 2018 to 2022, of which 51.3% (n=41) were cleft lip repair and 48.7% (n=39) were cleft palate repair. The average age at surgery was 4±5 years. Average averted DALYs ranged from 231.5 to 326.1 when utilizing the GBD and Effectiveness Factor Burden of Disease Calculation, respectively. This translated into an average of $24,130.14 to $76,987.60 economic gains per procedure. When considering the total economic impact of these procedures, this translated into $1,930,411.34 to $6,159,007.69 in economic productivity based on Atlas and Purchasing Power Parity calculations.
Conclusions:
This study highlights the importance of CL/P care in Botswana and the potential impact it has on patients and the large-scale economy. Despite the low numbers of CL/P repairs performed over this 5-year period, there was a meaningful reduction in disability and a resultant increase in the realization of economic gains, showing the need for continued investment in surgical capacity.
