Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, Maryland 21205, USA.
World J Surg. 2013 Jan;37(1):32-41. doi: 10.1007/s00268-012-1808-5.
Cost-effectiveness of tension-free inguinal hernia repair at a private 20-bed rural hospital in Esmeraldas Province, Ecuador, was calculated relative to no treatment.
Lichtenstein repair using mosquito net or polypropylene commercial mesh was provided to patients with inguinal hernia by surgeons from Europe and North America. Prospective data were collected from provider, patient, and societal perspectives, with component costs collected on site and from local supply companies or published literature. Patient outcomes were forecasted using disability adjusted life years (DALYs) averted. Uncertainty in patient-level data was evaluated with Monte-Carlo simulation.
Surgery was provided to 102 patients with inguinal hernias of various sizes. Local anesthesia was used for 80 % of operations during the first mission, and spinal anesthesia was used for 89 % in the second mission. Few complications were observed. An average 6.39 DALYs (3,0) were averted per patient (95 % confidence interval: 6.22-6.84). The average cost per patient was US$499.33 (95 % CI: US$490.19-$526.03) from a provider perspective, US$118.79 (95 % CI: US$110.28-$143.72) from a patient perspective, and US$615.46 (95 % CI: US$603.39-$650.40) from a societal perspective. Mean cost-effectiveness from a provider perspective was US$78.18/DALY averted (95 % CI: US$75.86-$85.78) according to DALYs (3,0) averted using the West Life Table level 26, well below the Ecuadorian per-capita Gross National Income (US$3,850). Results were robust to all sensitivity analyses.
Inguinal hernia repair was cost-effective in western Ecuador through international collaboration.
在厄瓜多尔埃斯梅拉达斯省的一家拥有 20 张床位的农村私人医院，对无治疗的情况下进行腹股沟疝修补术的成本效益进行了评估。
由来自欧洲和北美的外科医生使用蚊式网或商用聚丙烯网片为腹股沟疝患者实施了李金斯坦修补术。从提供者、患者和社会三个角度收集了前瞻性数据，并在现场和当地供应公司或已发表的文献中收集了各组成部分的成本。使用避免的伤残调整生命年（DALY）预测患者的结局。使用蒙特卡罗模拟评估患者水平数据的不确定性。
对 102 名患有不同大小腹股沟疝的患者进行了手术。第一次任务期间，80%的手术使用了局部麻醉，第二次任务期间，89%的手术使用了脊髓麻醉。仅观察到少数并发症。每位患者平均可避免 6.39 个伤残调整生命年（DALY）（95%置信区间：6.22-6.84）。从提供者角度来看，每位患者的平均成本为 499.33 美元（95%置信区间：490.19-526.03 美元），从患者角度来看，每位患者的平均成本为 118.79 美元（95%置信区间：110.28-143.72 美元），从社会角度来看，每位患者的平均成本为 615.46 美元（95%置信区间：603.39-650.40 美元）。根据使用西生命表第 26 级避免的 DALY（3.0），从提供者角度来看，平均成本效益为每避免一个 DALY 需花费 78.18 美元（95%置信区间：75.86-85.78 美元），远低于厄瓜多尔的人均国民总收入（3850 美元）。所有敏感性分析结果均稳健。
通过国际合作，在厄瓜多尔西部，腹股沟疝修补术具有成本效益。
