Can it be more cost-effective to prevent than to treat obstetric fistulas?

post by brb243 · 2022-01-10T19:39:18.030Z · EA · GW · None comments

This is a question post.

Summary: Am I making a mistake in assuming that an obstetric fistula can be prevented for $20? If not, should TLYCS recommend a charity that prevents fistulas?


According to Fistula Foundation, a TLYCS recommended charity, one successful surgery costs a total of about $700. ($586$694)/surgery and 86% success rate.

It can cost about $0.1 [EA · GW] to inform a person about a recommendation by a series of radio ads, newspapers, posters, and in-person interactions of local community members/volunteers so that 1 in 10 people implements an otherwise unthought of preventive healthcare behavior (% mask wearing graph [EA · GW]). This should be $1/person to implement a preventive measure. Assuming that the prevalence of fistulas is 0.3% and that the measure is 50% effective, then the prevention of one case should cost ~$670, which is close to the $700 to provide curative treatment.

Another approach can be targeting midwives to share information on when to seek specialized care and identify at-risk patients, training doctors at government (free of charge) clinics, providing equipment, and potentially offering travel stipend to extremely poor households. Assuming that a midwife takes care of 10,000 patients and training costs $100, that is $0.01/patient (considering the 0.3% prevalence, $3.3/patient). A doctor can take care of 1,000 at-risk patients, with the counterfactual prevention rate of 8% (assuming that 10% of patients would have otherwise developed a fistula and that the success rate of an intervention is 80%). Their training and additional equipment can cost $1,000, so additional $12.5/patient. A travel stipend can be $10 and 20% of patients can need it. That is $2/patient. This may motivate or enable 50% of patients who would otherwise suffer from a fistula to visit the clinic. So, $4/patient assuming the counterfactual. In total, training midwives and doctors, providing equipment, and providing travel stipend can prevent an obstetric fistula for about $20. This targeted preventive healthcare cost is about 35× lower than curative healthcare cost.


The counterargument is that all midwives and doctors are trained, have equipment, and travel stipend is available or that the additional cost is much higher for the remaining ones, which I do not think is the case.


Is there an organization working on preventing fistulas? Should TLYCS recommend that charity instead?


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