Cost-Effectiveness of Exploratory Laparotomy in a Regional Referral Hospital in Eastern Uganda
| Autor: | Mary Margaret Ajiko, Fred Kirya, Christopher De Boer, Andrew Hyginus Wange, Rochelle A. Dicker, Nikhil Bellamkonda, Catherine Juillard, Girish Motwani, Elliot Marseille |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Referral Exploratory laparotomy Cost effectiveness Cost-Benefit Analysis medicine.medical_treatment Measles Regional Health Planning Tertiary Care Centers Young Adult 03 medical and health sciences Life Expectancy 0302 clinical medicine Laparotomy medicine Humans Uganda Health Workforce Prospective Studies Child Developing Countries Equipment and Supplies Hospital health care economics and organizations Average cost Aged Aged 80 and over Health economics business.industry Infant Newborn Infant Middle Aged medicine.disease Child Preschool 030220 oncology & carcinogenesis Emergency medicine Female 030211 gastroenterology & hepatology Surgery Quality-Adjusted Life Years business Trauma surgery |
| Zdroj: | Journal of Surgical Research. 245:587-592 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2019.07.037 |
| Popis: | Background Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. Materials and methods A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. Results Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. Conclusions This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries. |
| Databáze: | OpenAIRE |
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