and middle-income countries - Lancet Commission on Global Surgery

Timing and cost of scaling up
surgical services in low- and
middle-income countries
Stéphane Verguet, Blake Alkire, Stephen Bickler, Jeremy Lauer,
Tarsicio Uribe-Leitz, George Molina, Thomas Weiser, Gavin Yamey,
Mark Shrime
[email protected]
Royal Society of Medicine, London, April 27 2015
Background
•  The Lancet’s Commission on Global Surgery proposes that
countries should achieve 5000 major operations per 100,000
population per year
•  We modeled the scale-up of surgical services in 88 low- and
middle-income countries with a population > 1 million over
2012-2030 at various rates and quantified associated costs
Modeling approach
Surgical volume
today in low- and
middle-income
countries!
!
Cost of surgical
volume scale-up !
Secular trends!
9% annual!
23% annual!
Surgical volume in
2030 in those
countries with target
of 5000 per 100,000
population!
Cost of new
operating rooms
construction!
Timing of surgical scale-up to target
AFG
MLI
BFA
TZA
BEN
NPL
HTI
BGD
KEN
KHM
ZWE
TJK
2040
TCD
KGZ
SEN
MRT
CMR
CIV
GHA IND
2030
BOL
PNG
VNM
UZB
MDA
NGA
COG
EGY
GTM
GEO
IDN
2020
ZMB
SDN
LSO
NIC
HND
YEM
PAK
LAO
ARM
LKAMAR
MNG
PHL
SWZ
PRY
SLV UKR
TUN
AGO
ALB BIH
CHN
JOR
MKD
DZA
ECUJAM
DOM
AZE BLR
BGR COL
IRQ
IRN
THA
SRB
TKM
NAM
PER
ZAF
5% annual rate of increase
50% of countries achieve target of
5000 per 100,000
2070
2060
Low-income countries
Lower middle-income countries
Upper middle-income countries
2050
TGOUGA
SLE
RWA
2040
MOZ
GMB
GNB
2030
2050
CAF
COD
NER
MDG
BDI
MWI
ETH
ERIGIN
CAF
GMB
GNB
LBR
MDG
MLI
HTI
KEN
KHM
AFG BFA
BEN
BGD
KGZ
COD
NER
MOZ
SLE
RWA
TGOUGA
TZA
NPL
TJK
TCD
ZWE
BOL
HND
YEM
PAK
LAO
SDN
NIC
PNG
ZMB
VNM
UZB
MDA
NGA
COG
ARM
AGO
SEN
MRT
CMR
CIV
LSO
GHA IND
2020
MWI
LBR
2010
BDI
Target achievement at Mongolian rates of improvements
Year by which 5,000 per 100,000 target is achieved
2070
2060
Low-income countries
Lower middle-income countries
Upper middle-income countries
ETH
ERIGIN
2010
Year by which 5,000 per 100,000 target is achieved
Target achievement at actual rates of improvements
LKAMAR
EGY
MNG
GTM
GEO IDN
PHL
SWZ
PRY
SLV UKR
TUN
JOR
MKD
DZA
ECU
THA
SRB
TKM
DOM JAM
NAM
CHN
PER
IRQ
AZE BLR
BGR COL IRN
ZAF
ALB BIH
9% annual rate of increase
67% of countries achieve target of
5000 per 100,000
Input costs (2012 US$)
Cost"
Low-income
countries!
Lower middleUpper middleincome countries! income countries!
Unit cost per
surgical procedure"
$180"
$220"
$330"
Construction cost
per operating room"
$300,000"
$400,000"
$1,900,000"
Source: Gibbons et al. 2010; Personal communications
Total cost (2012 billion US$) of surgical
scale-up, 2012-2030
Cost"
Low-income
countries!
Lower middleincome
countries!
Upper middleincome
countries!
Cost of surgical procedures"
14"
115"
86"
Cost of operating rooms"
6"
37"
40"
Total cost"
20"
152"
126"
Annual cost (% of total health expenditure)!
1 (4%)!
8 (4%)!
7 (1%)!
Cost of surgical procedures"
31"
197"
91"
Cost of operating rooms"
13"
50"
40"
Total cost"
44"
247"
131"
Annual cost (% of total health expenditure)!
2 (8%)!
14 (6%)!
7 (1%)!
Cost of surgical procedures"
76"
274"
95"
Cost of operating rooms"
17"
50"
40"
Total cost"
93"
324"
135"
Annual cost (% of total health expenditure)!
5 (17%) !
18 (8%)!
8 (1%)!
Secular rates of scale-up (5% per year)!
Mongolian rates of scale-up (9% annual)!
Mexican rates of scale-up (23% annual)!
Conclusions
•  Surgical scale-up for health system
development is substantial but affordable
•  Extreme scarcity of empirical data
•  Questions of human resource capacity,
quality and subnational distribution of
surgical services are essential
Reference & contact
•  Verguet S, Alkire BC, Bickler SW, et al. Timing and cost of
scaling up surgical services in low-income and middle-income
countries from 2012 to 2030: a modelling study. Lancet
Global Health 2015; 3: S28-37.
•  [email protected]