Is International Volunteer Surgery for Cleft Lip and Cleft Palate a Cost-Effective and Justifiable Intervention? A Case Study from East Asia

Although surgery provided by international volunteers is increasingly common in the developing world, there have been few assessments of the cost-effectiveness of these activities. In this context, this study covered 15 years of experience of one international nongovernmental organization, Smile for Children, in providing cleft lip (CL) and cleft palate (CP) surgical services in Vietnam. We analyzed the cost-effectiveness of the program and its contributions to building local capacity. To assess the cost-effectiveness of CL/CP surgery performed during Smile for Children's missions in Vietnam, we analyzed the data from four annual missions, from 2007 to 2010. According to the 2003 World Health Organization Guide to Cost-Effectiveness Analysis, we calculated cost per disability-adjusted life years (DALYs) averted with and without age weighting. For the data from the 2010 mission, we repeated the same calculation but with and without considering opportunity cost for labor. The discounted cost per DALY averted averaged $68, ranging from $52 to $79 depending on the year of the mission. The average discounted cost per DALY averted with age weighting was $56 (range $43-$65). For the calculation that takes into account the volunteers' possible income loss as the labor cost of the mission in 2010, the cost per DALY averted without age weighting increased by 28 %, from $76 to $97; and the cost per DALY averted with age weighting increased by 27 %, from $63 to $80. Under all of these varying assumptions, the CL/CP program operated by Smile for Children is a cost-effective intervention using international criteria for cost-effectiveness. The contribution of the international volunteer surgical team to building in-country capacity is notable. It was achieved primarily through training Vietnamese surgeons during the mission trips and through sending these surgeons to Korea for training. Other staff, including anesthesiologists, were also trained; and equipment and supplies were provided.