手术和产科护理在撒哈拉以南非洲地区医院是高成本效益的干预措施：一项关于手术成本和结果的单机构三个月研究。
Surgery and Obstetric Care are Highly Cost-Effective Interventions in a Sub-Saharan African District Hospital: A Three-Month Single-Institution Study of Surgical Costs and Outcomes.
作者信息
Roberts Geoffrey, Roberts Charlotte, Jamieson Amy, Grimes Caris, Conn Gemma, Bleichrodt Robert
出版信息
World J Surg. 2016 Jan;40(1):14-20. doi: 10.1007/s00268-015-3271-6.
BACKGROUND
The Lancet recently sponsored a commission examining the role of surgery in global health. There is a paucity of published information on the cost-effectiveness of surgery in low- and middle-income countries, a key metric in the prioritisation of limited resources.
METHODS
All patients undergoing emergency laparotomy, elective and emergency inguinal hernia repair, elective and emergency caesarean section, amputation, fracture manipulation, or fracture fixation over a 3 months period in a single district African hospital were assessed. World Health Organisation global burden of disease (GBD) methodology was used to calculate the disability-adjusted life years (DALYs) saved for each patient (using global and local life expectancy). Fully loaded costs were calculated for each patient’s care and providing the overall surgical service. Cost-effectiveness was calculated in year 2012 US$ per DALY saved for each procedure and overall.
RESULTS
A total of 428 patients were included, with an overall cost-effectiveness of $10.70 per DALY averted. The cost-effectiveness of individual procedures (global life expectancy) was: Amputation—$17.66; Emergency caesarean section—$7.42; Elective caesarean section—$20.50; Emergency laparotomy—$8.62; Elective hernia repair—$15.26; Emergency hernia repair—$4.36; Fracture/dislocation reduction—$69.03; Fracture/dislocation fixation—$225.89.
CONCLUSIONS
Surgery is a highly cost-effective healthcare measure in the setting of an African district hospital. The presented outcomes demonstrate that surgery is on a par with better-recognised and funded interventions such as HIV anti-retrovirals, malaria prevention and diarrhoea treatment. There are recognised limitations with the GBD methodology used here; however, this remains the best way to investigate the cost-effectiveness of health interventions. This study provides useful information on an, at present, under-studied field.
背景
《柳叶刀》杂志近期发起了一项委员会，探讨外科手术在全球健康中的作用。关于低收入和中等收入国家外科手术成本效益的已发表信息匮乏，而成本效益是在有限资源分配中进行优先级排序的关键指标。
方法
对一家非洲地区医院在3个月内接受急诊剖腹手术、择期和急诊腹股沟疝修补术、择期和急诊剖宫产、截肢、骨折整复或骨折固定的所有患者进行评估。采用世界卫生组织全球疾病负担（GBD）方法，计算每位患者节省的伤残调整生命年（DALY）（使用全球和当地预期寿命）。计算每位患者的护理以及提供整体外科服务的完全成本。计算每种手术及总体上每节省一个DALY的成本效益（以2012年美元计）。
结果
共纳入428例患者，总体成本效益为每避免一个DALY 10.70美元。各手术（全球预期寿命）的成本效益为：截肢——17.66美元；急诊剖宫产——7.42美元；择期剖宫产——20.50美元；急诊剖腹手术——8.62美元；择期疝修补术——15.26美元；急诊疝修补术——4.36美元；骨折/脱位复位——69.03美元；骨折/脱位固定——225.89美元。
结论
在非洲地区医院环境中，外科手术是一种极具成本效益的医疗保健措施。所呈现的结果表明，外科手术与诸如艾滋病毒抗逆转录病毒疗法、疟疾预防和腹泻治疗等更知名且资金投入更多的干预措施相当。此处使用的GBD方法存在公认的局限性；然而，这仍是研究卫生干预措施成本效益的最佳方法。本研究为目前研究不足的领域提供了有用信息。
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