Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Annals of surgery
Abstract
To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective.Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children.In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%.In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country’s gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses.Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.
Description
Keywords
charity, cost, cost-effectiveness analysis, DALY, disability-adjusted life year, expenditure, infrastructure, installation, operating room, outcomes, out-of pocket, pediatric surgery, Uganda, wages
Citation
Yap, A., Cheung, M., Muzira, A., Healy, J., Kakembo, N., Kisa, P., ... & Ozgediz, D. (2021). Best buy in public health or luxury expense?: The cost-effectiveness of a pediatric operating room in Uganda from the societal perspective. Annals of surgery, 273(2), 379.https://dx.doi.org/10.1097%2FSLA.0000000000003263