Löfgren Jenny, Mulowooza Jude, Nordin Pär, Wladis Andreas, Forsberg Birger C
Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden.
Iganga General Hospital, Iganga, Uganda.
Surgery. 2015 Jun;157(6):983-91. doi: 10.1016/j.surg.2015.01.026. Epub 2015 Apr 28.
Operative interventions have traditionally been seen as expensive; therefore, surgery has been given low priority in global health care planning in low-income countries. A growing body of evidence indicates that surgery can also be highly cost effective in low-income settings, but our current knowledge of the actual cost of surgery in such settings is limited. This study was carried out to obtain data on the costs of commonly performed operative procedures in a rural/semiurban setting in eastern Uganda.
A prospective, facility-based study carried out at a general district hospital (public) and a mission hospital (private, not-for-profit) in the Iganga and Mayuge districts in eastern Uganda. Items included in the cost calculations were staff time, materials and medicines, overhead costs, and capital costs.
The cost of surgery was higher at the mission hospital, with higher expenditure and lower productivity than the public hospital. The most commonly performed major procedures were caesarean section, uterine evacuation, and herniorrhaphy for groin hernia. The costs for these interventions varied between $68.4 and $74.4, $25.0 and $32.6, and $58.6 and $66.0, respectively. The most commonly performed minor procedures were circumcision, suture of cuts and lacerations, and incision and drainage of abscess. The costs for these interventions varied between $16.2 and $24.6, $15.8 and $24.3, and $10.1 and $18.6, respectively.
The cost of surgery in the study setting compares favorably with other prioritized health care interventions, such as treatment for tuberculosis, human immunodeficiency virus/AIDS, and childhood immunization. Surgery in low-income settings can be made more cost effective, leading to increased quantity and improved quality of surgical services.
手术干预传统上被视为成本高昂；因此，在低收入国家的全球卫生保健规划中，外科手术的优先级较低。越来越多的证据表明，在低收入环境中，手术也可能具有很高的成本效益，但我们目前对这种环境下手术实际成本的了解有限。本研究旨在获取乌干达东部农村/半城市地区常见手术操作成本的数据。
在乌干达东部伊甘加区和马尤盖区的一家区级综合医院（公立）和一家教会医院（私立，非营利性）进行了一项基于机构的前瞻性研究。成本计算中包括的项目有人员时间、材料和药品、间接费用以及资本成本。
教会医院的手术成本更高，与公立医院相比，支出更高但生产率更低。最常进行的主要手术是剖宫产、子宫排空以及腹股沟疝修补术。这些干预措施的成本分别在68.4美元至74.4美元、25.0美元至32.6美元以及58.6美元至66.0美元之间。最常进行的小手术是包皮环切术、伤口和裂伤缝合以及脓肿切开引流术。这些干预措施的成本分别在16.2美元至24.6美元、15.8美元至24.3美元以及10.1美元至18.6美元之间。
研究环境中的手术成本与其他优先的卫生保健干预措施（如结核病、人类免疫缺陷病毒/艾滋病治疗以及儿童免疫接种）相比具有优势。低收入环境中的手术可以提高成本效益，从而增加手术服务的数量并提高质量。
