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]
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