Cost-effectiveness of groin hernia surgery in the western region of Ghana

Samuel D. Shillcutt, Michael G. Clarke, Andrew N. Kingsnorth

Research output: Contribution to journalArticle

Abstract

Objective: To calculate the cost-effectiveness of tensionfree inguinal hernia repair with mosquito net mesh in the Western Region of Ghana. Design: Prospective study. Setting: Four district hospitals in the Western Region of Ghana. Patients: A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes. Intervention: Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons. Main Outcome Measure: Disability-adjusted lifeyears (DALYs) averted with counterfactual definitions based on precedent and expert opinion. Results: All operations were performed as day cases, with 81 of the patients (71.7%) under local anesthesia and few complications. An average of 9.3 (95% confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95% CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95% CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa. Conclusions: Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.

Original languageEnglish (US)
Pages (from-to)954-961
Number of pages8
JournalArchives of Surgery
Volume145
Issue number10
DOIs
StatePublished - 2010

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Ghana
Groin
Hernia
Cost-Benefit Analysis
Inguinal Hernia
Mosquito Nets
Herniorrhaphy
Confidence Intervals
Costs and Cost Analysis
District Hospitals
Expert Testimony
Local Anesthesia
Outcome Assessment (Health Care)
Prospective Studies
Research

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Cost-effectiveness of groin hernia surgery in the western region of Ghana. / Shillcutt, Samuel D.; Clarke, Michael G.; Kingsnorth, Andrew N.

In: Archives of Surgery, Vol. 145, No. 10, 2010, p. 954-961.

Research output: Contribution to journalArticle

Shillcutt, Samuel D. ; Clarke, Michael G. ; Kingsnorth, Andrew N. / Cost-effectiveness of groin hernia surgery in the western region of Ghana. In: Archives of Surgery. 2010 ; Vol. 145, No. 10. pp. 954-961.
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abstract = "Objective: To calculate the cost-effectiveness of tensionfree inguinal hernia repair with mosquito net mesh in the Western Region of Ghana. Design: Prospective study. Setting: Four district hospitals in the Western Region of Ghana. Patients: A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes. Intervention: Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons. Main Outcome Measure: Disability-adjusted lifeyears (DALYs) averted with counterfactual definitions based on precedent and expert opinion. Results: All operations were performed as day cases, with 81 of the patients (71.7{\%}) under local anesthesia and few complications. An average of 9.3 (95{\%} confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95{\%} CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95{\%} CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa. Conclusions: Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.",
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