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Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda
Gareth Eeson1, Doreen Birabwa-Male, Mark Pennington
1Department of Surgery, University of British Columbia, Room 3100, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada, gareth.eeson@gmail.com.
Insights
Pediatric inguinal hernia repair (PIHR) is a highly cost-effective intervention in low-resource settings, averting disability-adjusted life years (DALYs) at a low cost. Prioritizing PIHR in low- and middle-income countries (LMICs) is recommended for public health.
Area of Science:
- Global Health
- Surgical Public Health
- Health Economics
Background:
- Surgically treatable diseases cause significant disability worldwide but are neglected in low- and middle-income countries (LMICs).
- Pediatric inguinal hernia is a common congenital abnormality causing significant morbidity and mortality, yet repair is often unavailable in LMICs.
- This study assesses the cost and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource environment.
Purpose of the Study:
- To determine the costs associated with pediatric inguinal hernia repair (PIHR) in a low-resource setting.
- To evaluate the cost-effectiveness of PIHR in preventing disability-adjusted life years (DALYs).
- To inform public health policy regarding surgical interventions in LMICs.
Main Methods:
- Prospective recording of medical costs for elective PIHR at two Ugandan centers.
- Development of a Markov decision model comparing PIHR adoption versus non-adoption from a provider's perspective.
- Analysis of cost per DALY averted, with sensitivity analyses to test result robustness.
Main Results:
- Sixty-nine PIHRs were performed in 65 children, with a mean cost of $86.68 USD per procedure.
- Each PIHR procedure averted an average of 5.7 DALYs.
- The incremental cost-effectiveness ratio was $12.41 per DALY averted, with 95% probability of cost-effectiveness at $35 per DALY.
Conclusions:
- Elective PIHR is a highly cost-effective intervention for treating and preventing hernia complications, even in resource-limited settings.
- PIHR should be prioritized in LMICs as a public health intervention.
- The findings support the integration of PIHR into essential surgical services in low-resource countries.
Background:
Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting.
Methods:
Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention.
Results:
Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios.
Conclusion:
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.
