Lars Hagander

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.

Remarkable gains have been made in global health in the past 25 years, but progress has not been uniform. Mortality and morbidity from common conditions needing surgery have grown in the world’s poorest regions, both in real terms and relative to other health gains. At the same time, development of safe, essential, life-saving surgical and anesthesia care in low- and middleincome countries (LMICs) has stagnated or regressed. In the absence of surgical care, case-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labor, congenital anomalies, and breast and cervical cancer. Although the term, low- and middleincome countries (LMICs), has been used throughout the report for brevity, the Commission realizes that tremendous income diversity exists between and within this group of countries. In 2015, many LMICs are facing a multifaceted burden of infectious disease, maternal disease, neonatal disease, noncommunicable diseases, and injuries. Surgical and anesthesia care are essential for the treatment of many of these conditions and represent an integral component of a functional, responsive, and resilient health system. In view of the large projected increase in the incidence of cancer, road traffic injuries, and cardiovascular and metabolic diseases in LMICs, the need for surgical services in these regions will continue to rise substantially from now until 2030. Reduction of death and disability hinges on access to surgical and anesthesiacare,whichshouldbeavailable, affordable,timely,andsafetoensuregood coverage, uptake, and outcomes. Despite a growing need, the develop

Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis

BACKGROUND The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery. METHODS We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US

Global cancer surgery: delivering safe, affordable, and timely cancer surgery

. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist. FINDINGS Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision (

Surgery and global health: a Lancet Commission

13·78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations (

Global surgery: defining an emerging global health field

12·96-25·93 per DALY) and bednets for malaria prevention (

Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development

6·48-22·04 per DALY). Median CERs of cleft lip or palate repair (

An opportunity for diagonal development in global surgery: cleft lip and palate care in resource-limited settings

47·74 per DALY), general surgery (

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

82·32 per DALY), hydrocephalus surgery (

Global Surgery 2030: a roadmap for high income country actors

108·74 per DALY), and ophthalmic surgery (

Towards closing the gap of the global surgeon, anaesthesiologist, and obstetrician workforce: thresholds and projections towards 2030.

136 per DALY) were similar to that of the BCG vaccine (