Costs and Cost‐Effectiveness of Pediatric Inguinal Hernia Repair in Uganda

Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K.

doi:10.1007/s00268-014-2818-2

Cited by 37 publications

(22 citation statements)

References 25 publications

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“…Despite the fact that surgical procedures are cost-effective [ 51 ], only 10% of adults [ 36 ] and children get the surgery they need. Procedures performed at first-level hospitals have been found to be the most cost-effective [ 51 ], and surgical repair of pediatric inguinal hernia has been shown to be highly cost-effective [ 52 ]. The Lancet Commission on Global Surgery recently stratified common surgical procedures that must be done, should be done and can be done in first-level hospitals [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap

et al. 2017

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BackgroundIn low- and middle-income countries, there is a gap between the need for surgery and its equitable provision, and a lack of proxy indicators to estimate this gap. Sierra Leone is a West African country with close to three million children. It is unknown to what extent the surgical needs of these children are met.AimTo describe a nationwide provision of pediatric surgical procedures and to assess pediatric hernia repair as a proxy indicator for the shortage of surgical care in the pediatric population in Sierra Leone.MethodsWe analyzed results from a nationwide facility survey in Sierra Leone that collected data on surgical procedures from operation and anesthesia logbooks in all facilities performing surgery. We included data on all patients under the age of 16 years undergoing surgery. Primary outcomes were rate and volume of surgical procedures. We calculated the expected number of inguinal hernia in children and estimated the unmet need for hernia repair.ResultsIn 2012, a total of 2381 pediatric surgical procedures were performed in Sierra Leone. The rate of pediatric surgical procedures was 84 per 100,000 children 0–15 years of age. The most common pediatric surgical procedure was hernia repair (18%), corresponding to a rate of 16 per 100,000 children 0–15 years of age. The estimated unmet need for inguinal hernia repair was 88%.ConclusionsThe rate of pediatric surgery in Sierra Leone was very low, and inguinal hernia was the single most common procedure noted among children in Sierra Leone.

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Section: Discussionmentioning

confidence: 99%

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap

et al. 2017

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“…The procedure with the lowest minimum CER was $4-14/DALY for inguinal hernia repair in Uganda. [39] All interventions were very cost-effective at each country’s GDP level by WHO standards. When summarized by procedure group, there were 12 procedures with CER information using DALYs as the health outcome.…”

Section: Resultsmentioning

confidence: 99%

Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

et al. 2016

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BackgroundUnderstanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.FindingsWe identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.InterpretationOur findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.

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“…To bridge the gap of unmet pediatric surgical need, steps must be made in diagnostics, critical care, and curative services by specialized providers, rather than just expansion of basic medical care. In a cost-effectiveness analysis, pediatric inguinal hernia repairs performed in Uganda had a cost-effectiveness ratio of $12.41 per DALY averted, compared with $41 for insecticide-treated bed nets to prevent malaria [ 22 ]. It is worth investing in surgical infrastructure to address the large burden of pediatric surgical conditions.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey

et al. 2016

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PurposeLittle is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda.MethodsUsing the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0–18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates.ResultsOf 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths).ConclusionAlthough some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.

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Costs and Cost‐Effectiveness of Pediatric Inguinal Hernia Repair in Uganda

Abstract: Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

Cited by 37 publications

References 25 publications

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap

Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey

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