Economic benefit of neurosurgical intervention for infant hydrocephalus in Haiti

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OBJECTIVE

Previous models have been utilized in other low- and middle-income countries (LMICs) to explore and assess the cost, sustainability, and effectiveness of infant hydrocephalus treatment. However, similar models have not been implemented in Haiti due to a paucity of data, epidemiology, and outcomes for hydrocephalus. Therefore, the authors utilized previously described economic modeling to estimate the annual cost and benefit of treating hydrocephalus in infants at a neurosurgery referral center, Hospital Bernard Mevs (HBM), in Port-au-Prince, Haiti.

METHODS

The authors conducted a retrospective review of data obtained in all children treated for hydrocephalus at the HBM from 2008 to 2015. The raw data were pooled with previously described surgical outcomes for hydrocephalus in other LMICs. Modeling was performed to determine outcomes, neurosurgical costs, disability-adjusted life years (DALYs), and economic benefits of Haitian hydrocephalus treatment during this time frame. Standard account methodology was employed to calculate cost per procedure. Using these formulas, the net economic benefit and cost/DALY were determined for hydrocephalus treatment at HBM from 2008 to 2015.

RESULTS

Of the 401 patients treated during the study period, 158 (39.4%) met criteria for postinfectious hydrocephalus, 54 (13.5%) had congenital hydrocephalus, 38 (9.5%) had myelomeningocele, 19 (4.7%) had aqueductal stenosis, and 132 (33%) were not placed into a category. Overall, 317 individuals underwent surgical treatment of their hydrocephalus, averting 3077 DALYs. The total cost of the procedures was $754,000, and the cost per DALY ranged between $86 and $245. The resulting net economic benefit for neurosurgical intervention ranged from $2.5 to $5.5 million.

CONCLUSIONS

This work demonstrates the substantial economic benefit of neurosurgical intervention for the treatment of pediatric hydrocephalus at a single hospital in Haiti. Based on DALYs averted, the need for additional centers offering basic neurosurgical services is apparent. A single center offering these services for several days each month was able to generate between $2.5 to $5.5 million in economic benefits, suggesting the need to develop neurosurgical capacity building in Haiti. Ultimately, prevention, screening, and early surgical treatment of these infants represent a public health and socioeconomic requisite for Haiti.

ABBREVIATIONS CPC = choroid plexus cauterization; DALY = disability-adjusted life year; ETV = endoscopic third ventriculostomy; HBM = Hospital Bernard Mevs; IE = income elasticity; LMIC = low- and middle-income country; PIH = postinfectious hydrocephalus; PMHSS = Project Medishare Hydrocephalus Specialty Surgery; VPS = ventriculoperitoneal shunt; VSL = value of a statistical life.

Article Information

Correspondence John Ragheb: University of Miami Miller School of Medicine, Miami, FL. jragheb@med.miami.edu.

INCLUDE WHEN CITING Published online July 5, 2019; DOI: 10.3171/2019.4.PEDS18563.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Flow sheet demonstrating an overview of the DALYs-averted model. USD = US dollars; VSLY = VSL year.

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    Scenario 1 in which no neurosurgical intervention is performed. Estimations are based on assumptions from the referenced papers. DW = disability weighted. Figure is available in color online only.

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    Scenario 2 in which neurosurgical intervention is performed. Estimations are based on assumptions from the referenced papers. Figure is available in color online only.

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    Indirect sensitivity analysis for scenario 1. Figure is available in color online only.

  • View in gallery

    Indirect sensitivity analysis for scenario 2. Figure is available in color online only.

References

  • 1

    Barthélemy EJBenjamin EEdouard Jean-Pierre MYPoitevien GErnst SOsborn I: A prospective emergency department-based study of pattern and outcome of neurologic and neurosurgical diseases in Haiti. World Neurosurg 82:9489532014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Boulos ARand KJohnson JAGautier JKoster M: Neonatal sepsis in Haiti. J Trop Pediatr 63:70732017

  • 3

    DeGennaro V JrDeGennaro VABitar MBitar JThaller S: Building advanced surgical capacity at a hospital in Port-au-Prince, Haiti. J Craniofac Surg 26:104210472015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Devleesschauwer BHavelaar AHMaertens de Noordhout CHaagsma JAPraet NDorny P: Calculating disability-adjusted life years to quantify burden of disease. Int J Public Health 59:5655692014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Dewan MCRattani AMekary RGlancz LJYunusa IBaticulon RE: Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg 130:106510792019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Gosselin RAGialamas GAtkin DM: Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries. World J Surg 35:9519552011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Gosselin RAMaldonado AElder G: Comparative cost-effectiveness analysis of two MSF surgical trauma centers. World J Surg 34:4154192010

  • 8

    Hammitt JKRobinson LA: The income elasticity of the value per statistical life: transferring estimates between high and low income populations. J Benefit Cost Anal 2:1292011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Hoppe-Hirsch ELaroussinie FBrunet LSainte-Rose CRenier DCinalli G: Late outcome of the surgical treatment of hydrocephalus. Childs Nerv Syst 14:97991998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Kim SYLee GGoldie SJ: Economic evaluation of pneumococcal conjugate vaccination in The Gambia. BMC Infect Dis 10:2602010

  • 11

    Kim SYSweet SSlichter DGoldie SJ: Health and economic impact of rotavirus vaccination in GAVI-eligible countries. BMC Public Health 10:2532010

  • 12

    Laurence KMCoates S: The natural history of hydrocephalus. Detailed analysis of 182 unoperated cases. Arch Dis Child 37:3453621962

  • 13

    Lindquist BCarlsson GPersson EKUvebrant P: Learning disabilities in a population-based group of children with hydrocephalus. Acta Paediatr 94:8788832005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Lopez ADMathers CDEzzati MJamison DTMurray CJL (eds): Global Burden of Disease and Risk Factors. New York: Oxford University Press2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Meara JGGreenberg SL: The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery 157:8348352015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Murray CJAcharya AK: Understanding DALYs (disability-adjusted life years). J Health Econ 16:7037301997

  • 17

    Rudolfson NDewan MCPark KBShrime MGMeara JGAlkire BC: The economic consequences of neurosurgical disease in low- and middle-income countries. J Neurosurg 130:114911562019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Schiff SJRanjeva SLSauer TDWarf BC: Rainfall drives hydrocephalus in East Africa. J Neurosurg Pediatr 10:1611672012

  • 19

    Shillcutt SDClarke MGKingsnorth AN: Cost-effectiveness of groin hernia surgery in the Western Region of Ghana. Arch Surg 145:9549612010

  • 20

    Shrime MGBickler SWAlkire BCMock C: Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3 (Suppl 2):S8S92015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Viscusi WKAldy JE: The value of a statistical life: a critical review of market estimates throughout the world. J Risk Uncertain 27:5762003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Warf BC: Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 103 (6 Suppl):4754812005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Warf BC: Pediatric hydrocephalus in East Africa: prevalence, causes, treatments, and strategies for the future. World Neurosurg 73:2963002010

  • 24

    Warf BCAlkire BCBhai SHughes CSchiff SJVincent JR: Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. J Neurosurg Pediatr 8:5095212011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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