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Economic benefit of neurosurgical intervention for infant hydrocephalus in Haiti.
Hubbard, Zachary S; Shah, Ashish H; Ragheb, Michael; Wang, Shelly; Jernigan, Sarah; Ragheb, John.
Afiliação
  • Hubbard ZS; 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
  • Shah AH; 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and.
  • Ragheb M; 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and.
  • Wang S; 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
  • Jernigan S; 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
  • Ragheb J; 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and.
J Neurosurg Pediatr ; : 1-9, 2019 Jul 05.
Article em En | MEDLINE | ID: mdl-31277055
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Health_economic_evaluation / Prognostic_studies Aspecto: Patient_preference País/Região como assunto: Haiti Idioma: En Revista: J Neurosurg Pediatr Assunto da revista: NEUROCIRURGIA / PEDIATRIA Ano de publicação: 2019 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Health_economic_evaluation / Prognostic_studies Aspecto: Patient_preference País/Região como assunto: Haiti Idioma: En Revista: J Neurosurg Pediatr Assunto da revista: NEUROCIRURGIA / PEDIATRIA Ano de publicação: 2019 Tipo de documento: Article País de publicação: Estados Unidos