Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery Programs in Low- and Middle-Income Countries

Cardarelli, Marcelo; Vaikunth, Sumeet S.; Mills, Katie; DiSessa, Thomas G.; Molloy, Frank; Sauter, Elizabeth; Bowtell, Karen; Rivera, Roslyn; Shin, Andrew; Novick, William M.

doi:10.1001/jamanetworkopen.2018.4707

Cited by 65 publications

(42 citation statements)

References 46 publications

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“…The average cost per patient, including hospital discount, is $19,800 in our setting, whereas, in many developing countries, the reported cost of pediatric cardiac surgery is described within a range of $3.000-10.000 (22,27). This significant difference is due to the strategic decision taken by our program to model our pediatric cardiac surgery center using examples from the developed world, which incurs substantial costs related to maintenance, equipment, safety, training, excellent outcome measures, and appropriate salaries to retain the talented human resources.…”

Section: Discussionmentioning

confidence: 79%

“…Nevertheless, cardiac surgery for CHD remains an essential part of pediatric health care for the following considerations: ( 1 ) our profession's moral imperative is to treat these children, regardless of any financial concern; ( 2 ) denying care for children with CHD, would not improve the care of other diseases: due to inefficient governance, denying funds to CHD doesn't mean that these funds would be allocated to strengthen other health care issues; ( 3 ) according to the United Nations, treating CHD offers considerable economic value in terms of human development ( 22 , 23 ). In 2018, Cardarelli et al analyzed 446 patients operated in several low and middle-income countries to estimate the improvement in the United Nations Human Development Indicators for each survivor as a proxy for the long-term benefits of the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In 2018, Cardarelli et al analyzed 446 patients operated in several low and middle-income countries to estimate the improvement in the United Nations Human Development Indicators for each survivor as a proxy for the long-term benefits of the intervention. He concluded that treating these children was equivalent to 1,484 years of schooling, and 67,640,000$ gained by the entire cohort ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

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Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned

et al. 2020

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Background: Developing countries are profoundly affected by the burden of congenital heart disease (CHD) because of limited resources, poverty, cost, and inefficient governance. The outcome of pediatric cardiac surgery in developing countries is suboptimal, and the availability of sustainable programs is minimal. Aim: This study describes the establishment of a high quality in-situ pediatric cardiac surgery program in Lebanon, a limited resource country. Methods: We enrolled all patients operated for CHD at the Children's Heart Center at the American University of Beirut between January 2014 and December 2018. Financial information was obtained. We established a partnership between the state, private University hospital, and philanthropic organizations to support the program. Results: In 5 years, 856 consecutive patients underwent 993 surgical procedures. Neonates and infants constituted 22.5 and 22.6% of our cohort, respectively. Most patients (82.6%) underwent one cardiac procedure. Our results were similar to those of the Society of Thoracic Surgeons (STS) harvest and to the expected mortalities in RACHS-1 scores with an overall mortality of 2.8%. The government (Public) covered 43% of the hospital bill, the Philanthropic organizations covered 30%, and the Private hospital provided a 25% discount. The parents' out-of-pocket contribution included another 2%. The average cost per patient, including neonates, was $19,800. Conclusion: High standard pediatric cardiac surgery programs can be achieved in limited-resource countries, with outcome measures comparable to developed countries. We established a viable financial model through a tripartite partnership between Public, Private, and Philanthropy (3P system) to provide high caliber care to children with CHD.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned

et al. 2020

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“…We believe that there is a role for these short-term missions. In a detailed study of the financial implications of their many short term missions to LMICs, Cardarelli et al have shown the cost effectiveness of intervention and the benefit to the society (14). In 2015, 446 patients received intervention in 10 LMICs at a total cost of $3,210,873.…”

Section: Short Term Medical Missionsmentioning

confidence: 99%

Pediatric Cardiac Surgery in Low-and Middle-Income Countries: Present Status and Need for a Paradigm Shift

2019

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In low and mid-income countries, there has been a 50% global decrease in the incidence of preventable deaths of children since 1990. However, the mortality from non-communicable diseases (NCD) such as congenital heart disease (CHD) has not changed. Of the estimated 1.3 million children born with CHD annually, over 90% do not have access to cardiac care. With the increasing fertility rates in sub-Saharan Africa, the health burden of CHD will increase as well. Over the last 30 years much has been achieved with short term cardiac medical missions. However, much remains to be done to provide long term solutions needed to achieve the sustainable development goal of reducing deaths of children <5 years of age. This review discusses the present status and the need for a paradigm shift to achieve long term sustainability.

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“…Cardiac surgery is expensive and largely inaccessible without comprehensive public or private health insurance or philanthropic support to carry the financial burden for patients. Despite concerns regarding costs of cardiac surgery in low- and middle-income countries (LMICs) and small island developing states (SIDS), initial data suggest favourable cost-effectiveness to establish and operate local cardiac centers in LMICs and SIDS alike [2] , [3] , [4] .…”

Section: Introductionmentioning

confidence: 99%

Adult cardiac surgical cost variation around the world: Protocol for a systematic review

Vervoort

Guetter

Trager

et al. 2020

International Journal of Surgery Protocols

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Highlights Cardiac surgery is expensive and poses financial barriers for underinsured patients. Substantial cost variation exists among non-cardiac surgical procedures worldwide. Little is known regarding cardiac surgery cost variation worldwide. This systematic review evaluates global cost variation in adult cardiac surgery. Results may inform cost-reducing practices to increase access to cardiac surgery.

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Cost-effectiveness of Humanitarian Pediatric Cardiac Surgery Programs in Low- and Middle-Income Countries

Cited by 65 publications

References 46 publications

Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned

Establishing a High-Quality Congenital Cardiac Surgery Program in a Developing Country: Lessons Learned

Pediatric Cardiac Surgery in Low-and Middle-Income Countries: Present Status and Need for a Paradigm Shift

Adult cardiac surgical cost variation around the world: Protocol for a systematic review

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