Surgery and Obstetric Care are Highly Cost-Effective Interventions in a Sub-Saharan African District Hospital: A Three-Month Single-Institution Study of Surgical Costs and Outcomes
Surgery and Obstetric Care are Highly Cost-Effective Interventions in a Sub-Saharan African District Hospital: A Three-Month Single-Institution Study of Surgical Costs and Outcomes
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DOI：
10.1007/s00268-015-3271-6
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发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Bleichrodt, Robert
中科院分区：
文献类型：
--
作者：
Roberts, Geoffrey;Roberts, Charlotte;Bleichrodt, Robert
背景：《柳叶刀》杂志最近发起了一个委员会，研究外科手术在全球健康中的作用。关于低收入和中等收入国家手术的成本效益的公开信息很少，这是确定有限资源优先顺序的关键指标。方法对在一家非洲地区医院接受了3个月的紧急剖腹手术、选择性和紧急腹股沟疝修补术、选择性和紧急剖腹产、截肢、骨折操作或骨折固定的所有患者进行评估。采用世界卫生组织全球疾病负担(GBD)方法计算为每个患者节省的伤残调整寿命年(使用全球和当地预期寿命)。计算了每个病人的护理和提供整体手术服务的全负荷成本。结果共纳入428例患者，避免每例DALY的总成本效果为10.70美元。个别手术的成本效益(全球预期寿命)是截肢--17.66美元紧急剖腹产-7.42美元选择性剖腹产-20.50美元紧急剖腹手术-8.62美元选择性疝修补术-15.26美元紧急疝修补术-4.36美元骨折/脱位复位术-69.03美元骨折/脱位固定术-225.89美元。提出的结果表明，手术与更受认可和资助的干预措施，如艾滋病毒抗逆转录病毒药物、疟疾预防和腹泻治疗，不相上下。这里使用的GBD方法有公认的局限性；然而，这仍然是调查卫生干预措施成本效益的最佳方式。这项研究为目前研究不足的领域提供了有用的信息。
Background The Lancet recently sponsored a commission examining the role of surgery in global health. There is a paucity of published information on the cost-effectiveness of surgery in low- and middle-income countries, a key metric in the prioritisation of limited resources.Methods All patients undergoing emergency laparotomy, elective and emergency inguinal hernia repair, elective and emergency caesarean section, amputation, fracture manipulation, or fracture fixation over a 3 months period in a single district African hospital were assessed. World Health Organisation global burden of disease (GBD) methodology was used to calculate the disability-adjusted life years (DALYs) saved for each patient (using global and local life expectancy). Fully loaded costs were calculated for each patient's care and providing the overall surgical service. Cost-effectiveness was calculated in year 2012 US$ per DALY saved for each procedure and overall.Results A total of 428 patients were included, with an overall cost-effectiveness of $10.70 per DALY averted. The cost-effectiveness of individual procedures (global life expectancy) wasAmputation-$17.66Emergency caesarean section-$7.42Elective caesarean section-$20.50Emergency laparotomy-$8.62Elective hernia repair-$15.26Emergency hernia repair-$4.36Fracture/dislocation reduction-$69.03Fracture/dislocation fixation-$225.89Conclusions Surgery is a highly cost-effective healthcare measure in the setting of an African district hospital. The presented outcomes demonstrate that surgery is on a par with better-recognised and funded interventions such as HIV anti-retrovirals, malaria prevention and diarrhoea treatment. There are recognised limitations with the GBD methodology used here; however, this remains the best way to investigate the cost-effectiveness of health interventions. This study provides useful information on an, at present, under-studied field.