Evidence from the CURE Children's Hospital of Uganda (CCHU) suggests that treatment for hydrocephalus in infants can be effective and sustainable in a developing country. This model has not been broadly supported or implemented due in part to the absence of data on the economic burden of disease or any assessment of the cost and benefit of treatment. The authors used economic modeling to estimate the annual cost and benefit of treating hydrocephalus in infants at CCHU. These results were then extrapolated to the potential economic impact of treating all cases of hydrocephalus in infants in sub-Saharan Africa (SSA).
The authors conducted a retrospective review of all children initially treated for hydrocephalus at CCHU via endoscopic third ventriculostomy or shunt placement in 2005. A combination of data and explicit assumptions was used to determine the number of times each procedure was performed, the cost of performing each procedure, the number of disability-adjusted life years (DALYs) averted with neurosurgical intervention, and the economic benefit of the treatment. For CCHU and SSA, the cost per DALY averted and the benefit-cost ratio of 1 year's treatment of hydrocephalus in infants were determined.
In 2005, 297 patients (median age 4 months) were treated at CCHU. The total cost of neurosurgical intervention was $350,410, and the cost per DALY averted ranged from $59 to $126. The CCHU's economic benefit to Uganda was estimated to be between $3.1 million and $5.2 million using a human capital approach and $4.6 million–$188 million using a value of a statistical life (VSL) approach. The total economic benefit of treating the conservatively estimated 82,000 annual cases of hydrocephalus in infants in SSA ranged from $930 million to $1.6 billion using a human capital approach and $1.4 billion–$56 billion using a VSL approach. The minimum benefit-cost ratio of treating hydrocephalus in infants was estimated to be 7:1.
Untreated hydrocephalus in infants exacts an enormous price from SSA. The results of this study suggest that neurosurgical intervention has a cost/DALY averted comparable to other surgical interventions that have been evaluated, as well as a favorable benefit-cost ratio. The prevention and treatment of hydrocephalus in SSA should be recognized as a major public health priority.
Abbreviations used in this paper: CCHU = CURE Children's Hospital of Uganda; CPC = choroid plexus cauterization; DALY = disability-adjusted life year; ETV = endoscopic third ventriculostomy; GNI = gross national income; IE-VSL = income elasticity of VSL; PIH = postinfectious hydrocephalus; PPP = purchasing power parity; SSA = sub-Saharan Africa; VSL = value of a statistical life.
ChiJHFullertonHJGuptaN: Time trends and demographics of deaths from congenital hydrocephalus in children in the United States: National Center for Health Statistics data, 1979 to 1998. J Neurosurg103:2 Suppl113–1182005
ChotivitayatarakornPChotivitayatarakornPPoovorawanY: Cost-effectiveness of rotavirus vaccination as part of the national immunization program for Thai children. Southeast Asian J Trop Med Public Health41:114–1252010
Environmental Protection Agency National Center for Environmental Economics: Frequently Asked Questions on Mortality Risk Valuation(http://yosemite.epa.gov/ee/epa/eed.nsf/pages/MortalityRiskValuation.html
US Department of Transportation Office of the Secretary of Transportation: Treatment of the Economic Value of a Statistical Life in Departmental Analyses(http://ostpxweb.dot.gov/policy/reports/080205.htm
WarfBOndomaSKulkarniADonnellyRAmpeireMAkonaJ: Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. Clinical article. J Neurosurg Pediatr4:564–5702009
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 Suppl475–4812005
WarfBCCampbellJW: Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment of hydrocephalus for infants with myelomeningocele: long-term results of a prospective intent-to-treat study in 115 East African infants. Clinical article. J Neurosurg Pediatr2:310–3162008
WarfBCKulkarniAV: Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children. Clinical article. J Neurosurg Pediatr5:204–2092010
WarfBCMugambaJKulkarniAV: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success. Clinical article. J Neurosurg Pediatr5:143–1482010
WarfBCStagnoVMugambaJ: Encephalocele in Uganda: ethnic distinctions in lesion location, endoscopic management of hydrocephalus, and survival in 110 consecutive children. Clinical article. J Neurosurg Pediatr7:88–932011