AI Article Synopsis
- Surgical disease significantly contributes to global mortality, yet data on cost-effectiveness for essential surgical procedures are lacking, prompting this study to analyze exploratory laparotomies in Uganda.
- By collecting data on 103 patients over 8 months, the average cost per case was found to be $75.50, with a postoperative mortality rate of 11.7% and an average of 18.51 DALYs averted per patient, translating to a cost of $4.08 per DALY averted.
- The findings indicate that exploratory laparotomy is more cost-effective compared to other public health interventions, advocating for increased investment in surgical capacities in low- and middle-income nations due to the high burden of surgically treatable conditions
Article Abstract
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.
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| http://dx.doi.org/10.1016/j.jss.2019.07.037 | DOI Listing |
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