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Cost-effectiveness of a pediatric operating room installation in Sub-Saharan Africa
Ava Yap1,2, Salamatu I Halid3, Nancy Ukwu3
1Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
Insights
Investing in dedicated pediatric operating rooms in Nigeria is highly cost-effective. This initiative significantly reduces disability-adjusted life years (DALYs) and strengthens global surgery infrastructure for children in Sub-Saharan Africa.
Area of Science:
- Global Health
- Health Economics
- Pediatric Surgery
Background:
- Sub-Saharan Africa (SSA) faces significant health and economic burdens due to the unmet need for pediatric surgery.
- Limited understanding of the economic impact of pediatric surgical infrastructure hinders resource allocation in SSA.
- Children constitute a substantial portion of the population in SSA, highlighting the critical need for surgical services.
Purpose of the Study:
- To assess the cost-effectiveness of establishing and operating two dedicated pediatric operating rooms (ORs) in a Nigerian hospital.
- To provide data supporting informed resource allocation for pediatric surgical infrastructure in SSA.
- To bolster global surgery initiatives for children in resource-limited settings.
Main Methods:
- A decision tree model was constructed to simulate pediatric surgical delivery over one year.
- Scenarios were compared before and after the installation of philanthropically funded pediatric ORs.
- Cost-effectiveness was measured using disability-adjusted life years (DALYs) averted and incremental cost-effectiveness ratios (ICERs) from an all-payer perspective.
Main Results:
- The installation and operation of two pediatric ORs averted 538 DALYs annually at a cost of $177,527.
- The ICER was $330 per DALY averted, well below Nigeria's cost-effectiveness threshold.
- Sensitivity analyses confirmed the robustness of the cost-effectiveness findings.
Conclusions:
- Establishing dedicated pediatric ORs in Nigeria with existing surgical capacity is a very cost-effective intervention.
- Investment in pediatric surgical infrastructure in SSA is an economically sound strategy for improving global child surgery outcomes.
- The findings support increased funding for pediatric surgical services in resource-limited regions.
Abstract:
The unmet need for pediatric surgery imposes enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of knowledge about the economic impact of improving pediatric surgical infrastructure in SSA inhibits the informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and running two dedicated pediatric operating rooms (ORs) in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of the ORs, which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital's operative registry and prior literature. We adopted an all healthcare payor's perspective including costs incurred by the local healthcare system, the installation (funded by the charity), and patients' families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation and operation were presented. One-way and probabilistic sensitivity analyses were performed. We found that installing and operating two dedicated pediatric ORs averted 538 DALYs and cost $177,527 annually. The ICER of the ORs' installation and operation was $330 per DALY averted (95% uncertainty interval [UI] 315-336) from the all healthcare payor's perspective. This ICER was well under the cost-effectiveness threshold of the country's half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional dedicated pediatric operating rooms in Nigeria with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children's global surgical infrastructure as an economically sound intervention.
