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Cost-effectiveness of neonatal surgery for congenital anomalies in low-income and middle-income countries: a systematic review protocol
  1. Na Eun Kim1,2,
  2. Dominique Vervoot3,
  3. Ahmad Hammouri4,
  4. Cristiana Riboni5,
  5. Hosni Salem6,
  6. Caris Grimes2,7,
  7. Naomi Jane Wright8
  1. 1 Department of General Surgery, Boston Medical Center, Boston, Massachusetts, USA
  2. 2 King's College London, London, UK
  3. 3 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4 Department of Internal Medicine, Bethlehem Arab Society for Rehabilitation, Bethlehem, Palestine, State of
  5. 5 University of Pavia, Pavia, Lombardia, Italy
  6. 6 Cairo University, Giza, Egypt
  7. 7 Department of Surgery, Medway NHS Foundation Trust, Gillingham, Kent, UK
  8. 8 King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
  1. Correspondence to Dr Na Eun Kim;{at}


Introduction Congenital anomalies are the fifth leading cause of death in children under 5 years old globally (591 000 deaths reported in 2016). Over 95% of deaths occur in low-income and middle-income countries (LMICs). It is estimated that two-thirds of the congenital anomaly health burden could be averted through surgical intervention and that such interventions can be cost-effective. This systematic review aims to evaluate current evidence regarding the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs.

Methods and analysis A systematic literature review will be conducted in PubMed, MEDLINE, Embase, Cochrane Library, Scielo, Google Scholar, African Journals OnLine and Regional WHO’s African Index Medicus databases for articles on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs. The following search strings will be used: (1) congenital anomalies; (2) LMICs; and (3) cost-effectiveness of surgical interventions. Articles will be uploaded to Covidence software, duplicates removed and the remaining articles screened by two independent reviewers. Cost information for interventions or procedures will be extracted by country and condition. Outcome measurements by reported unit and cost-effectiveness ratios will be extracted. Methodological quality of each article will be assessed using the Drummond checklist for economic evaluations. The Agency for Healthcare Research and Quality’s Effective Health Care Program guidance will be followed to assess the grade of the studies.

Ethics and dissemination No ethical approval is required for conducting the systematic review. There will be no direct collection of data from individuals. The finalised article will be published in a scientific journal for dissemination. The protocol has been registered with PROSPERO (International Prospective Register of Systematic Reviews).

Conclusion Congenital anomalies form a large component of the global health burden that is amenable to surgical intervention. This study will systematically review the current literature on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs.

PROSPERO registration number CRD42020172971.

  • neonatology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors All authors contributed to the design of the systematic review and drafted the manuscript including its revisions. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work and ensure that questions related to the accuracy of the work are appropriately investigated and resolved.

  • Funding NJW receives funding from the Wellcome Trust to undertake a Clinical PhD in Global Health at King’s Centre for Global Health and Health Partnerships, King’s College London (funder reference: 203905/Z/16/Z).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no data sets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information. Data availability is not applicable for the systematic review protocol as no data will be collected. All data gathered during the systematic review will be made available with the publication of the results.

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