Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing.
Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing.
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DOI：
10.1002/bjs5.35
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发表时间：
2018-03
期刊：
影响因子：
3.1
通讯作者：
Hedt-Gauthier B
中科院分区：
文献类型：
--
作者：
Ruhumuriza J;Odhiambo J;Riviello R;Lin Y;Nkurunziza T;Shrime M;Maine R;Omondi JM;Mpirimbanyi C;de la Paix Sebakarane J;Hagugimana P;Rusangwa C;Hedt-Gauthier B
在低收入和中等收入国家，由于人员和基础设施有限，大多数患者无法获得手术治疗。柳叶刀全球外科委员会建议在地区医院进行剖腹手术。然而，很少有人知道剖腹手术和相关的临床护理在这些设置的成本。这项成本计算研究包括2015年卢旺达三家农村地区医院的急腹症患者，并使用了基于时间驱动的活动成本计算方法。计算人员、地点和医院间接成本的能力成本率，并乘以时间估计数以获得分配成本。药品和用品的费用是根据购买价格计算的。在51名急腹症患者中，19名（37%）接受了剖腹手术;其中17名患者的全部成本数据可用，他们被纳入成本分析。剖腹手术的整个护理周期的总成本为1023.40美元，其中包括术中成本427.15美元（41.7%）和术前和术后成本596.25美元（58.3%）。药品费用为358.78美元（35.1%），用品费用为342.15美元（33.4%），人员费用为150.39美元（14.7%），地点费用为89.20美元（8.7%），医院间接费用为82.88美元（8.1%）。剖腹手术的术中成本与之前的估计相似，但任何扩大地区医院剖腹手术能力的计划都应考虑到相当大的术前和术后成本。虽然缺乏人员和有限的基础设施通常被认为是地区医院的手术障碍，但人员和地点成本是最低的成本因素;三级医院与地点相关的类似费用可能高于地区医院，为这些服务的分散提供进一步支持。
In low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings. This costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices. Of 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent). The intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.
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作者：
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