Economic benefits and costs of surgery for filarial hydrocele in Malawi

Author summary Lymphatic filariasis (LF) is endemic in 72 countries of Africa, Asia, Oceania, and the Americas. It causes painful, disabling hydrocele in an estimated 25 million men. Hydrocele leads to reduced mobility, social exclusion, and depression, all of which limit the men's ability to work. Filarial hydrocele can be corrected with surgery with few complications. We measured the economic loss due to hydrocele and the benefits of hydrocelectomy in two districts in southern Malawi. We calculated lost earnings over the lifetime due to filarial hydrocele and compared it to the costs of surgery to determine the benefit-cost ratio. The ratio of the benefit of surgery to its cost is US$1684/US$68 or 24.8. The results are robust to variations in cost of surgery and length of working life. Scaling up subsidies to hydrocelectomy campaigns should be a priority for governments and international aid organizations to prevent and alleviate disability and lost earnings that aggravate poverty among the many millions of men with filarial hydrocele, their families, and their communities. Background Lymphatic filariasis (LF) is endemic in 72 countries of Africa, Asia, Oceania, and the Americas. An estimated 25 million men live with the disabling effects of filarial hydrocele. Hydrocele can be corrected with surgery with few complications. For most men, hydrocelectomy reduces or corrects filarial hydrocele and permits them to resume regular activities of daily living and gainful employment. Methodology and principal findings This study measures the economic loss due to filarial hydrocele and the benefits of hydrocelectomy and is based on pre- and post-operative surveys of patients in southern Malawi. We find the average number of days of work lost due to filarial hydrocele and daily earnings for men in rural Malawi. We calculate average annual lost earnings and find the present discounted value for all years from the time of surgery to the end of working life. We estimate the total costs of surgery. We compare the benefit of the work capacity restored to the costs of surgery to determine the benefit-cost ratio. For men younger than 65 years old, the average annual earnings loss attributed to hydrocele is US$126. The average discounted present value of lifetime earnings loss for those men is US$1684. The average budgetary cost of the hydrocelectomy is US$68. The ratio of the benefit of surgery to its costs is US$1684/US$68 or 24.8. Sensitivity analysis demonstrates that the results are robust to variations in cost of surgery and length of working life. Conclusion The lifetime benefits of hydrocelectomy-to the man, his family, and his community-far exceed the costs of repairing the hydrocele. Scaling up subsidies to hydrocelectomy campaigns should be a priority for governments and international aid organizations to prevent and alleviate disability and lost earnings that aggravate poverty among the many millions of men with filarial hydrocele.