| Summary: | Background: The Solidarity Bridge Medical Program (SBMP) supplies surgical tools and instrumentation to the underserved populations of Bolivia, Latin America’s poorest nation. Through collaborative work with in-country social workers and public hospital surgeons, patients that live in deep poverty and otherwise could not afford the cost of treatment are selected to receive necessary instrumentation as determined by licensed physicians.
Purpose: The purpose of this study was to examine the cost-utility of neurosurgical and pacemaker interventions for select populations in two major Bolivian cities, provided by SBMP.
Methods: From September 2010 to January 2011, approximately 36 pacemaker patients and 21 neurosurgery patients were interviewed both pre- and post-operatively. Included in the surveys were general demographic information as well as retrospective and prospective symptomatic data, self-assessment of overall health, and functional restrictions/limitations that affect patient health utility (or quality of life). Utility data for the neurosurgical program was derived from the standardized HUI-3, while utility data from the pacemaker program was modeled after the EQ-5D. Some modifications were necessary in both sets of collection due to cultural and situational barriers associated with the patient population. Cost information was collected from financial records of Solidarity Bridge as well as during patient surveys. Cost-utility results were analyzed to determine whether or not the program(s) is/are effective.
Results: With varying times of post-operative follow-up, patients in both programs, on average exhibited an increase in overall health classification and decrease in associated symptoms and functional limitations. Neurosurgery patients reported a mean increase of 4.45 on their overall health evaluation (scale from 1-10) from pre- to post-operatively, with 94% of patients exhibiting an overall increase in quality of life. The cost-utility of SBMP neurosurgical intervention at 2yrs assuming a 94% retention rate, 5yrs with 94% retention rate, and 5yrs with 50% retention rate was approximately $1,395/quality-adjusted life years (QALY), $2,664/QALY, and $11,112/QALY, respectively. The cost-utility under the same conditions for pacemaker implementation was $3,725/QALY, $2,193/QALY, and $9,155/QALY, respectively. Additionally, pacemaker patients reported an average increase of 4.57 on the same overall health evaluation, with 97.22% of them displaying an increase from their pre- to post-operative state.
Conclusion: In both the neurosurgery and pacemaker programs, there was a statistically significant increase in mean satisfaction and mean utility post-operatively (p<.0001). According to WHO threshold values for cost-effectiveness in Bolivia, the extrapolated values from both neurosurgery and pacemaker subgroups are considered highly cost-effective at 2- and 5-year intervals. If retention were lowered to 50% (from 94% observed in our subgroup), both programs would still be considered cost-effective at 2-and 5-year intervals. Further data collection and analysis with a larger cohort is necessary to improve strength and accuracy of these figures.
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