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

Autor:	Chung KY; Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.; Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, ON, Canada., Ho G; Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada., Erman A; Toronto Health Economics and Technology Assessment (THETA), University of Toronto, University Health Network, Toronto, ON, Canada., Bielecki JM; Toronto Health Economics and Technology Assessment (THETA), University of Toronto, University Health Network, Toronto, ON, Canada., Forrest CR; Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada., Sander B; Toronto Health Economics and Technology Assessment (THETA) collaborative, University Health Network, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.; Public Health Ontario, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association [Cleft Palate Craniofac J] 2023 Dec; Vol. 60 (12), pp. 1600-1608. Date of Electronic Publication: 2022 Jul 03.
DOI:	10.1177/10556656221111028
Abstrakt:	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. Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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