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The cost-effectiveness of orthopaedic clinical officers in Malawi
Caris E Grimes1, Nyengo C Mkandawire2, Michael L Billingsley3
1Global Surgery Associate, Kings Centre for Global Health, Kings College London and King's Health Partners, London, UK carisgrimes@doctors.org.uk.
Background:
In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program.
Methods:
Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted.
Results:
The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58-207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the 'economically active' demographic of ages 15-74 years.
Conclusion:
Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.
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