A cost-effectiveness analysis of surgical care delivery in Eastern Uganda-a societal perspective

Obieze Nwanna-Nzewunwa, Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
Esther Agwang, Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Melissa Carvalho, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA.
Mary-Margaret Ajiko, Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Rasheedat Oke, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA.
Christopher Yoon, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Mohamed M. Diab, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Fred Kirya, Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.
Elliot Marseille, Principal, Health Strategies International, 555 59th Street, Oakland, CA, USA.
Catherine Juillard, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA.
Rochelle A. Dicker, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA. rdicker@mednet.ucla.edu.

Abstract

BACKGROUND: The mismatch between the global burden of surgical disease and global health funding for surgical illness exacerbates disparities in surgical care access worldwide. Amidst competing priorities, governments need to rationally allocate scarce resources to address local needs. To build an investment case for surgery, economic data on surgical care delivery is needed. This study focuses on femur fractures. METHODS: This prospective cohort study at Soroti Regional Referral Hospital (SRRH), captured demographic, clinical, and cost data from all surgical inpatients and their caregivers at SRRH from February 2018 through July 2019. We performed descriptive and inferential analyses. We estimated the cost effectiveness of intramedullary nailing relative to traction for femur fractures by using primary data and making extrapolations using regional data. RESULTS: Among the 546 patients, 111 (20.3%) had femur fractures and their median [IQR] length of hospitalization was 27 days [14, 36 days]. The total societal cost and Quality Adjusted Life Year (QALY) gained was USD 61,748.10 and 78.81 for femur traction and USD 23,809 and 85.47 for intramedullary nailing. Intramedullary nailing was dominant over traction of femur fractures with an Incremental Cost Effectiveness Ratio of USD 5,681.75 per QALY gained. CONCLUSION: Femur fractures are the most prevalent and most expensive surgical condition at SRRH. Relative to intramedullary nailing, the use of femur traction at SRRH is not cost effective. There is a need to explore and adopt more cost-effective approaches like internal fixation.