Background Cost-effectiveness evidence is a critical tool to support resource allocation decisions. There is growing recognition that the development of benefit packages for surgical care should be guided by such evidence, particularly in resource-constraint settings. Methods We conducted a systematic review of evidence (Medline, Embase, Global Health, EconLit and grey literature) on the cost-effectiveness of surgery across low-income and middle-income countries published between January 2013 and January 2023. We included studies with minor and major therapeutic surgeries and minimally invasive intraluminal and endovascular interventions. We computed and compared the average cost-effectiveness ratios (ACERs) for different surgical interventions to the respective national gross domestic product per capita to determine cost-effectiveness and to common traditional public health interventions. Results We identified 87 unique studies out of 20 070 articles screened. Studies spanned 23 countries, with China (n=20), Thailand (n=12), Brazil (n=8) and Iran (n=8) accounting for about 55% of the evidence. Overall, the median ACERs across procedure groups ranged from I$17/disability-adjusted life year (DALY) for laparotomies to I$170 186/DALY for bariatric surgeries. Most of the ACER estimates were classified as cost-effective (89%) or very cost-effective (76%). Low-complexity surgical interventions compared favourably to common public health interventions. Conclusion These findings reinforce the growing body of evidence that investments in surgery are economically smart. There remains however paucity of high-quality evidence that would allow decision-makers to assess the comparative cost-effectiveness of surgery and to determine best buys across a wide range of specialties and interventions. A concerted effort is needed to advance the generation and utilisation of economic evidence in the drive towards scale-up of surgical care across low-income and middle-income countries. 

Cost-effectiveness of surgical interventions in low-income and middle-income countries: a systematic review and critical analysis of recent evidence

Background The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up. Methods Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL. Results A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%. Conclusions AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.

/pdf/evaluating-the-cost-effectiveness-of-catheter-ablation-of-3kzgavy2lb.pdf

Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation

Background: Evidence available on atrial fibrillation in Pakistan is not enough. Therefore, present study aims to determine frequency of atrial fibrillation and its associated complications. Place and duration of study: This cross sectional study was conducted at Department of Medicine, at SKBZ/AK CMH Muzaffarabad (Tertiary Care Hospital Muzaffarabad AJK) from July to December, 2019. Methodology: Total 1100 patients included for this study through non-probability consecutive sampling. Ethical approval and consent forms were taken. Patients were examined for atrial fibrillation through ECG. The patients who were confirmed as AF were detail examined and their cause and complications were noted down. Data was analyzed with SPSS version 24. One sample t test was used to predict AF in the population Chi-square test was applied. P value ≤0.05 was considered significant. Results: Out of 1100 patients mean age of patients was 43.4±12.7 years. The male to female ratio was 11:10. The atrial fibrillation was diagnosed in 250 (22.7%). In our population, at least 20% of the patients are having issue of atrial fibrillation with p value 0.016. The percentage of AF was higher in female 40.4% as compared to male 6.9%. Similarly the percentage of AF was higher in hypertensive patients (37.8%) as compared to non-hypertensive patients (12.3%). Conclusion:The prevalence of atrial fibrillation is moderately high in our data. Our sample results support the hypothesis that female are mostly with AF. Hence there is need to take measures to prevent them. Keywords: Atrial fibrillation, Causes of atrial fibrillation, Complications of atrial fibrillation

Frequency of Atrial Fibrillation and Its Complication

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Evaluating the cost-effectiveness of catheter ablation of atrial fibrillation