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. 2023 Dec;60(12):1600-1608.
doi: 10.1177/10556656221111028. Epub 2022 Jul 3.

A Systematic Review of the Cost-Effectiveness of Cleft Care in Low- and Middle-Income Countries: What is Needed?

Karen Y Chung  1   2 , George Ho  1 , Aysegul Erman  3 , Joanna M Bielecki  3 , Christopher R Forrest  1 , Beate Sander  2   4   5   6
Affiliations

A Systematic Review of the Cost-Effectiveness of Cleft Care in Low- and Middle-Income Countries: What is Needed?

Karen Y Chung et al. Cleft Palate Craniofac J. 2023 Dec.

Abstract

Objective: The objective of this paper is to conduct a systematic review that summarizes the cost-effectiveness of cleft lip and/or palate (CL/P) care in low- and middle-income countries (LMICs) based on existing literature.

Design: We searched eleven electronic databases for articles from January 1, 2000 to December 29, 2020. This study is registered in PROSPERO (CRD42020148402). Two reviewers independently conducted primary and secondary screening, and data extraction.

Setting: All CL/P cost-effectiveness analyses in LMIC settings.

Patients, participants: In total, 2883 citations were screened. Eleven articles encompassing 1,001,675 patients from 86 LMICs were included.

Main outcome measures: We used cost-effectiveness thresholds of 1% to 51% of a country's gross domestic product per capita (GDP/capita), a conservative threshold recommended for LMICs. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) checklist.

Results: Primary CL/P repair was cost-effective at the threshold of 51% of a country's GDP/capita across all studies. However, only 1 study met at least 70% of the JBI criteria. There is a need for context-specific cost and health outcome data for primary CL/P repair, complications, and existing multidisciplinary management in LMICs.

Conclusions: Existing economic evaluations suggest primary CL/P repair is cost-effective, however context-specific local data will make future cost-effectiveness analyses more relevant to local decision-makers and lead to better-informed resource allocation decisions in LMICs.

Keywords: cleft; cost-effectiveness; global surgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram.
Figure 2.
Figure 2.
Joanna Briggs Institute (JBI) critical appraisal checklist for economic evaluations.
See this image and copyright information in PMC

References

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