The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

Kramer, Erik; Shearer, David; Marseille, Elliot; Haonga, Billy; Ngahyoma, Joshua; Eliezer, Edmund; Morshed, Saam

doi:10.1007/s00268-016-3496-z

Cited by 11 publications

(11 citation statements)

References 45 publications

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“…Previous studies at the same institution in Tanzania have shown that femoral nailing with the same SIGN IM nail is a more cost-effective treatment compared to traction based on cost of treatment, as have studies using the same nail in Kenya and Cambodia [3, 12, 13]. While at a different anatomic location, our results support these studies in the use of IMN as a cost effective surgical management modality that should not be hindered by limited availability.…”

Section: Discussionsupporting

confidence: 83%

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Haonga

Areu

Challa

et al. 2019

SICOT-J

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Introduction: Open tibia fractures are some of the most common types of Orthopedics injuries in low- and middle-income countries (LMICs). In Tanzania, open tibia fractures are treated either conservatively by prolonged cast or surgically by external fixation (EF) or intramedullary nail (IMN) when available. The cost of treatment and amount of time patients spend away from work are major economic concerns with prolonged casting and EF. The goal of this study was to determine the cost effectiveness of IMN versus EF in the treatment of open diaphyseal tibia fractures at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania). Methods: This is a prospective randomized control study conducted of patients with a closeable AO/OTA 42 open diaphyseal tibia fracture. The patients underwent surgical fixation with either IMN or EF at Muhimbili Orthopaedic Institute (MOI), and were followed up at 2, 6, and 12 weeks postoperatively. A micro-costing method was used to estimate the fixed and variable costs of IMN and EF of the open diaphyseal tibial fracture. Results: The mean total cost per patient was lower for the IMN group ($425.8 ± 38.4) compared to the EF group ($559.6 ± 70.5, p < 0.001), with savings of $133.80 per patient for the IMN group. The mean hospital stay was 2.72 ± 1.40 days for the IMN group and 2.44 ± 1.47 days for the EF group (p = 0.5). Quality-adjusted life years (QALYs) were 0.26 per patient for the IMN group and 0.24 in the EF group at 12 weeks (p = 0.8). Ninety-two percent of patients in the IMN group achieved fracture union versus 60% in the EF group at three months postoperatively (p = 0.03). Conclusion: IM nailing of a closeable open diaphyseal tibial fracture is more cost effective than EF. In addition, IM nailing has better union rates at three months compared to EF.

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Section: Discussionsupporting

confidence: 83%

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Haonga

Areu

Challa

et al. 2019

SICOT-J

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“…Granted that increased risk of infection with use of internal fixation as a first line treatment in open fractures may be one reason for this practice, the other major reason is unavailability of implants which are prohibitively expensive 39,40 ; even closed fractures requiring surgical fixation are commonly managed conservatively for this reason. 14,41 This study reveals that surgical debridement plus conservative treatment (US$1177) is in fact more costly than ORIF (US$618) as a result of this prolonged ward stay. Although the ORIF cost here excludes the cost of implants (about US$134 14 ), since they were not captured in the routine hospital cost records, it includes the costs of prolonged preoperative clinic visits.…”

Section: Discussionmentioning

confidence: 90%

“…14,41 This study reveals that surgical debridement plus conservative treatment (US$1177) is in fact more costly than ORIF (US$618) as a result of this prolonged ward stay. Although the ORIF cost here excludes the cost of implants (about US$134 14 ), since they were not captured in the routine hospital cost records, it includes the costs of prolonged preoperative clinic visits. Indeed, cost-effectiveness studies in Kenya 42 and the United States 43 had demonstrated that internal fixation offers better clinical outcomes at lower costs compared to non-operative fixation of fractures.…”

Section: Discussionmentioning

confidence: 90%

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

Ifeanyichi¹,

Broekhuizen²,

Juma

et al. 2021

Int J Health Policy Manag

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Background: Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Methods: Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. Results: The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Conclusion: Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.

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“…A large prospective cohort study was recently completed in Tanzania demonstrating that surgical treatment is safe and effective when performed with intramedullary implants rather than plates and screws (29). Secondary studies have also demonstrated the potential cost savings associated with access to efficient surgical treatment and relatively poor outcomes with skeletal traction (30, 31). A multicenter study is currently ongoing in Malawi to establish the cost-effectiveness of surgical treatment compared to skeletal traction.…”

Section: Methodological Aspectsmentioning

confidence: 99%

The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery

Conway

Coughlin

Caldwell

et al. 2017

Front. Public Health

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In 2006, surgeons at the University of California, San Francisco (UCSF) established the Institute for Global Orthopedics and Traumatology (IGOT), an initiative within the department of orthopedic surgery. The principal aim of IGOT is to create long-term, sustainable solutions to the growing burden of musculoskeletal injury in low- and middle-income countries (LMICs) through academic partnership. IGOT currently has relationships with teaching hospitals in Ghana, Malawi, Tanzania, Nicaragua, and Nepal. The organizational structure of IGOT is built on four pillars: Global Surgical Education (GSE), Global Knowledge Exchange (GKE), Global Research Initiative (GRI), and Global Leadership and Advocacy. GSE focuses on increasing surgical knowledge and technical proficiency through hands-on educational courses. The GKE facilitates the mutual exchange of surgeons and trainees among IGOT and its partners. This includes a global resident elective that allows UCSF residents to complete an international rotation at one of IGOT’s partner sites. The GRI strives to build research capacity and sponsor high-quality clinical research projects that address questions relevant to local partners. The fourth pillar, Global Leadership and Advocacy aims to increase awareness of the global impact of musculoskeletal injury through national and international courses and events, such as the Bay Area Global Health Film Festival. At the core of each tenet is the collaboration among IGOT and its international partners. Over the last decade, IGOT has experienced tremendous growth and maturation in its partnership model based on cumulative experience and the needs of its partners.

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The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

Cited by 11 publications

References 45 publications

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery

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