Estimation of impact of surgical disease through economic modeling of cleft lip and palate care

World J Surg. 2010 Mar;34(3):391-6. doi: 10.1007/s00268-009-0198-9.


Background: Assessing burden of disease encompasses the prevalence of disease entities, but it is the impact that affects the populace. Similarly, optimal evaluation of intervention programs shows impact rather than simply an enumeration of services. Economic effects are a fungible measure but are difficult to assess. Modeling of economic effects was used to evaluate a cleft program in Nepal and to demonstrate impact of alleviating this subset of the surgical burden of disease.

Methods: The database of patients who underwent care at a cleft center in Katmandu in 2005 was used. Disability adjusted life years averted were calculated. Using both GNI per capita and Value of a Statistical Life, the economic value to the individuals and to society was calculated.

Results: The two methods yielded a conservative and a generous estimate of economic impact of treating cleft lip and palate. Using GNI per capita, cleft lip repair added between $856 and $6,598 to lifetime individual income. For cleft palate, this ranged from $2,293 to $17,278. Using Value of a Statistical Life, cleft lip repair added between $56,919 and $143,363, and cleft palate between $152,372 and $375,412.

Conclusions: The immense economic gain realized by an intervention addressing a small proportion of the surgical burden of disease indicates the importance of these conditions to public health and well-being. This methodology also lends itself to broader use and to further refinement as a means of evaluation of interventions. This has implications for health policy and for funding and resource allocation for surgical conditions in the developing world.

MeSH terms

  • Cleft Lip / surgery*
  • Cleft Palate / surgery*
  • Humans
  • Models, Economic