Abstract:
Of the 4.8 billion people in the world who lack access to safe surgical care, cleft lip and/or palate (CL/P) is the most common craniofacial congenital surgical condition. Ethiopia is the second most populous country in Africa, with a reported CL/P estimate of 1 in 672 live births; yet, over 70% of patients with CL/P lack access to surgery and even more lack access to postoperative speech care. Recent World Health Assembly resolutions have urged member states to strengthen systems for surgical and anesthesia care, and establish national systems of Health Technology Assessment (HTA) to inform priority setting, selection, and use of health technologies to inform public policy and clinical practice guidelines. Ethiopia has subsequently established a national Health Economics and Financing Analysis team to support policymakers with resource allocation decision-making. However, the local health impact and costs associated with CL/P, along with the cost-effectiveness of key scale-up considerations for surgery and speech care in Ethiopia is unknown. The overall objective of this thesis is to develop and use high-quality, context-relevant health economic evidence to support health policy decision-making regarding resource allocation for scaling up CL/P care in Ethiopia. The first study conducted was a systematic literature review of the cost-effectiveness of CL/P primary surgical repair in low-and-middle-income countries and identified gaps in the literature.