Cost-Effectiveness Analysis of Inguinal Hernia Repair With Mesh Performed by Surgeons and Medical Doctors in Ghana
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Value In Health Regional Issues
Abstract
Objectives: Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our
knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting.
This study has aimed to evaluate and compare the cost-effectiveness of mesh repair performed by Ghanaian surgeons and
medical doctors (MDs) following a standardized training program.
Methods: This cost-effectiveness analysis included data for 223 operations on adult men with primary reducible inguinal
hernia. cost per surgery was calculated from the perspective of the healthcare system. Disability weights were calculated using
pre- and postoperative pain scores and benchmarks from the Global Burden of Disease Study 2017.
Results: The mean cost/disability-adjusted life-year (DALY) averted in the surgeon group was 444.9 United States dollars
(USD) (95% confidence interval [CI] 221.2-668.5) and 278.9 USD (95% CI 199.3-358.5) in the MD group (P = .168),
indicating that the operation is very cost-effective when performed by both providers. The incremental cost (DALY) averted
showed that task-sharing with MDs is also very cost-effective (95% bootstrap CI 2436.7 to 454.9). The analysis found that
increasing provider salaries is cost-effective if productivity remains high. When only symptomatic cases were analyzed,
the mean cost/DALY averted reduced to 232.0 USD (95% CI 17.1-446.8) for the surgeon group and 129.7 USD (95% CI 79.6-
179.8) for the MD group (P = .348), and the incremental cost/DALY averted increased by 45% but remained robust.
Conclusions: Elective inguinal hernia repair with mesh performed by Ghanaian surgeons and MDs is a low-cost procedure and
very cost-effective in the context of the study. To maximize cost-effectiveness, symptomatic patients should be prioritized
over asymptomatic patients and a high level of productivity should be maintained
Description
Research Article
Keywords
cost-effectiveness analysis, global surgery, task-sharing.