Obstructed Labor and Caesarean Delivery The Cost and Benefit of Surgical Intervention 英文参考文献.docVIP

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Obstructed Labor and Caesarean Delivery The Cost and Benefit of Surgical Intervention 英文参考文献.doc

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Obstructed Labor and Caesarean Delivery The Cost and Benefit of Surgical Intervention 英文参考文献

ObstructedLaborandCaesareanDelivery:TheCostand BenefitofSurgicalIntervention BlakeC.Alkire1,2.,JeffreyR.Vincent3.,ChristyTurlingtonBurns4,IanS.Metzler2,PaulE.Farmer5, JohnG.Meara2,6 * 1DepartmentofOtologyandLaryngology,HarvardMedicalSchool,Boston,Massachusetts,UnitedStatesofAmerica,2PrograminGlobalSurgeryandSocialChange, DepartmentofGlobalHealthandSocialMedicine,HarvardMedicalSchool,Boston,Massachusetts,UnitedStatesofAmerica,3NicholasSchooloftheEnvironmentand SanfordSchoolofPublicPolicy,DukeUniversity,Durham,NorthCarolina,UnitedStatesofAmerica,4DepartmentofPopulationandFamilyHealth,MailmanSchoolof PublicHealth,ColumbiaUniversity,NewYork,NewYork,UnitedStatesofAmerica,5DepartmentofGlobalHealthandSocialMedicine,HarvardMedicalSchool,Boston, Massachusetts,UnitedStatesofAmerica,6DepartmentofPlasticandOralSurgery,Children’sHospitalBoston,Boston,Massachusetts,UnitedStatesofAmerica Abstract Background:Althoughadvancesinthereductionofmaternalmortalityhavebeenmade,upto273,000womenwilldiethis yearfromobstetricetiologies.Obstructedlabor(OL),mostcommonlytreatedwithCaesareandelivery,hasbeenidentified asamajorcontributortoglobalmaternalmorbidityandmortality.Weusedeconomicandepidemiologicalmodelingto estimate the cost per disability-adjusted life-year (DALY) averted and benefit-cost ratio of treating OL with Caesarean deliveryfor49countriesidentifiedasprovidinganinsufficientnumberofCaesareandeliveriestomeetdemand. MethodsandFindings:Usingpubliclyavailabledataandexpliciteconomicassumptions,weestimatedthatthecostper DALY(3,0,0)avertedforprovidingCaesareandeliveryforOLrangedwidely,from$251perDALYavertedinMadagascarto $3,462inOman.ThemediancostperDALYavertedwas$304.Benefit-costratiosalsovaried,from0.6inZimbabweto69.9 inGabon.Themedianbenefit-costratiocalculatedwas6.0.Themainlimitationofthisstudyisanassumptionthatlackof surgicalcapacityisthemainfactorresponsibleforDALYsfromOL. Conclusions: Using the World Health Organization’s cost-effectiveness standards, investing in Caesarean delive