Stories about: cost-effective care

Time for surgery to go global — even cost data support the argument

Cost-effectiveness ratios for many surgical procedures turn out to be comparable to those for many accepted global public health strategies.
Cost-effectiveness ratios for many surgical procedures are comparable to those for accepted global public health strategies.
While moral arguments have been made to bring surgical treatments to resource-poor countries, researchers from Boston Children’s Hospital have discovered that it also may be cost-effective.

Traditionally, global health initiatives have focused on infectious disease or HIV/AIDS outreach. However, more recent data, including a 2012 study in The Lancet, show a growing global burden of noncommunicable diseases, such as cancer, that require surgical treatment.

Surgical disease was previously thought to comprise at least 11 percent of the total global burden of disease, but the Lancet paper showed approximately 25 percent of people requiring surgical assessment, based on a widespread survey in Sierra Leone. Additional research has revealed that up to 85 percent of pediatric patients in Africa have a surgical condition by the age of 15 years.

“However, the prevailing perception is that surgical care is too expensive and not cost-effective enough to bring to developing countries,” states Tiffany E. Chao, MD, a Paul Farmer Global Surgery Fellow in the Plastic and Oral Surgery Department at Boston Children’s.

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Reducing unnecessary care: The SCAMPs manifesto

Can we reduce health care costs without rationing? (Image: Fibonacci Blue via Flickr)

We all know the problem: The cost of health care needs to come down. About five years ago, pediatric cardiologists at Children’s Hospital Boston realized it was critical to practice more cost-effectively. “Most of the money that is going to be removed from the federal budget to reduce budgetary deficits is going to come from health care in one fashion or another,” cardiologist-in-chief James Lock told an audience of senior Children’s physicians last month. “There’s no question we were under a tremendous amount of pressure.”

Seeking to eliminate unnecessary care and testing, Lock’s team first turned to clinical practice guidelines, or CPGs, a tool meant to standardize “best practices.” But it soon became clear that CPGs were ineffective, giving no insight into how to improve care or how to deal with unexpected findings. Even worse, over time, many mandated CPGs have been shown to be wrong by subsequent data.

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