Humanitarian Cardiac-Surgery Programs for Kids Highly Cost-Effective

By Will Boggs MD

December 03, 2018

NEW YORK (Reuters Health) - Humanitarian pediatric cardiac surgery in low- and middle-income countries (LMICs) is highly cost-effective, at less than $200 per disability-adjusted life-year averted, researchers report.

"The real surprise came in the form of the long-term effects on the lives of those children and the societies where they live," Dr. Marcelo Cardarelli from Inova Children Hospital, in Falls Church, Virginia, told Reuters Health by email. "At almost 40 years of potential extra life expectancy, 3.5 extra years of education, and nearly $160,000 of lifetime income, the impact, or what we call the 'Humanitarian Footprint,' was really surprising."

Global-health interventions - infectious-disease prevention or treatment, improvements in maternal and child care, sanitation and clean water and the like - are often highly cost-effective and help achieve local public-health goals. But little is known about the economic impact of humanitarian programs focused on the surgical treatment of congenital heart disease.

Dr. Cardarelli and colleagues investigated the cost-effectiveness of a humanitarian intervention aiming to build global pediatric cardiac-surgery programs, an initiative of the William Novick Global Cardiac Alliance.

During 2015, 446 patients underwent surgical treatment during 26 two-week trips to centers in 10 LMICs at a total program service cost of $3,210,873 (an estimated $6,831 per surgery), the team reports in JAMA Network Open, online November 16.

Among the 424 children younger than 16 years who underwent surgical treatment for their heart condition, the unadjusted mortality rate was 8% (34/424).

After subtracting the negative effects of surgery, each patient potentially gained 39.9 years of life expectancy, 3.5 years of schooling, and $159,533 gross national income per capita.

Overall, this translated to a humanitarian footprint of 16,932 years of life expectancy added, 1,484 years of schooling, and $67,642,191 national income gained by the entire cohort.

The largest program service expenses were cashless and included the estimated wages lost by the 378 volunteers ($1,479,014) and donated medicines and disposables ($443,652).

The surgical procedures performed in these patients addressed 27 uniquely identifiable cardiac malformations, the most common of which were atrial septal defect, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot and single ventricle.

Dr. Cardarelli said, "There are basically 3 types of factors limiting the ability to care for every single child born with congenital heart disease (over 900,000/year) and to prevent the death of 250,000 of them in the first weeks of life: diagnostic capabilities in every country, clinical facilities where diagnoses and treatments can be done, and, most importantly, the human resources to carry out the tasks involved."

"From the operational-costs point of view and using our costs as a guide, if the equipment, buildings, and human resources were in place, it would cost around $2B/year to solve this problem - nothing in the big scheme of resources dedicated to so many other enterprises," he said.

"Just to put things in perspective, since readers may be overwhelmed by the big price tag, $2B is barely 5% of the total amount spent in Global Humanitarian interventions by countries, WHO, Bill Gates Foundation, etc."

"Caring for children born with congenital heart disease goes far beyond saving a particular life," Dr. Cardarelli said. "The unintended consequences of our actions have tremendous repercussions on local healthcare systems, staff education, education in general, fertility rates, wealth creation, etc. There are probably many paths by which LMIC can move forward and improve their human development status. In any path they choose, the health of their children should be a constant presence."


JAMA Netw Open 2018.