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Surgery. 2018 Nov;164(5):953-959. doi: 10.1016/j.surg.2018.03.023. Epub 2018 May 23.

A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda.

Author information

1
Yale University School of Medicine, New Haven, CT, USA. Electronic address: avacyap@gmail.com.
2
Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
3
Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
4
The ARCHIE Foundation, University of Aberdeen, Scotland.
5
Department of Health Management and Policy, Yale School of Public Health, New Haven, CT, USA.

Abstract

This study examines the cost-effectiveness of constructing a dedicated pediatric operating room (OR) in Uganda, a country where access to surgical care is limited to 4 pediatric surgeons serving a population of over 20 million children under 15 years of age.

METHODS:

A simulation model using a decision tree template was developed to project the cost and disability-adjusted life-years saved by a pediatric OR in a low-income setting. Parameters are informed by patient outcomes of the surgical procedures performed. Costs of the OR equipment and a literature review were used to calculate the incremental cost-effectiveness ratio of a pediatric OR. One-way and probabilistic sensitivity analysis were performed to assess parameter uncertainty. Economic monetary benefit was calculated using the value of a statistical life approach.

RESULTS:

A pediatric OR averted a total of 6,447 disability-adjusted life-years /year (95% uncertainty interval 6,288-6,606) and cost $41,182/year (UI 40,539-41,825) in terms of OR installation. The pediatric operating room had an incremental cost-effectiveness ratio of $6.39 per disability-adjusted life-year averted (95% uncertainty interval of 6.19-6.59), or $397.95 (95% uncertainty interval of 385.41-410.67) per life saved based on the country's average life expectancy in 2015. These values were well within the WHO guidelines of cost-effectiveness threshold. The net economic benefit amounted to $5,336,920 for a year of operation, or $16,371 per patient. The model remained robust with one-way and probabilistic sensitivity analyses.

CONCLUSION:

The construction of a pediatric operating room in Uganda is a cost-effective and worthwhile investment, endorsing future decisions to enhance pediatric surgical capacity in the resource-limited settings of Sub-Saharan Africa.

PMID:
29801729
DOI:
10.1016/j.surg.2018.03.023

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