Abdelgadir Jihad, Tran Tu, Muhindo Alex, Obiga Doomwin, Mukasa John, Ssenyonjo Hussein, Muhumza Michael, Kiryabwire Joel, Haglund Michael M, Sloan Frank A
Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA.
Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA.
World Neurosurg. 2017 May;101:651-657. doi: 10.1016/j.wneu.2017.02.048. Epub 2017 Feb 16.
There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning.
In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda).
During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%).
This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.
低收入和中等收入国家尚无神经外科手术费用的数据。本研究的目的是估计资源匮乏地区神经外科手术的费用，以便更好地为资源分配和卫生部门规划提供信息。
在这项观察性经济分析中，采用微观成本核算来估计穆拉戈国家转诊医院（乌干达坎帕拉）神经外科手术的直接和间接费用。
在2014年10月至2015年9月的研究期间，共审查了1440份病历。其中，434例患者接受了手术，另外1006例接受了非手术治疗。该医院进行了13种类型的手术。神经外科手术的估计平均费用为542.14美元（标准差[SD]，253.62美元）。不同手术的平均费用从钻孔引流的291美元（SD，101美元）到脑肿瘤切除的1221美元（SD，473美元）不等。对于大多数手术，间接费用占总成本的比例最大（29%-41%）。
这是第一项使用原始数据确定资源匮乏地区神经外科手术费用的研究。手术室容量可能是手术量的限制性约束因素，因此，投资建设手术室应能实现更高的效率水平。本研究结果可供利益相关者和政策制定者用于资源分配，并进行经济分析，以确定神经外科手术在实现全球卫生目标方面的价值。
