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.
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.
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.
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.
ABBREVIATIONSCPC = 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.
Correspondence John Ragheb: University of Miami Miller School of Medicine, Miami, FL. firstname.lastname@example.org.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.
BarthélemyEJBenjaminEEdouard Jean-PierreMYPoitevienGErnstSOsbornI: A prospective emergency department-based study of pattern and outcome of neurologic and neurosurgical diseases in Haiti. World Neurosurg82:948–9532014
BarthélemyEJ, BenjaminE, Edouard Jean-PierreMY, PoitevienG, ErnstS, OsbornI, : A prospective emergency department-based study of pattern and outcome of neurologic and neurosurgical diseases in Haiti. 82:948–953, 201410.1016/j.wneu.2013.10.01224121294)| false
DevleesschauwerB, HavelaarAH, Maertens de NoordhoutC, HaagsmaJA, PraetN, DornyP, : Calculating disability-adjusted life years to quantify burden of disease. 59:565–569, 20142475242910.1007/s00038-014-0552-z)| false
GosselinRA, GialamasG, AtkinDM: Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries. 35:951–955, 201110.1007/s00268-010-0947-921350899)| false
MearaJG, GreenbergSL: The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. 157:834–835, 20152593401910.1016/j.surg.2015.02.009)| false
WarfBC: 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 Neurosurg103 (6 Suppl):475–4812005
WarfBC: 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. 103 (6 Suppl):475–481, 200516383244)| false