Grimes Caris E, Law Rebekah, Dare Anna, Day Nigel, Reshamwalla Sophie, Murowa Michael, George Peter M, Kamara Thaim B, Mkandawire Nyengo C, Leather Andrew J M, Lavy Christopher B D
King's Centre for Global Health and Health Partnerships, King's College London and King's Health Partners, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
Medway NHS Foundation Trust, Gillingham, Kent, UK.
World J Surg. 2017 Sep;41(9):2187-2192. doi: 10.1007/s00268-017-4007-6.
District hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Previous studies have suggested that government hospitals are likely to be highly cost-effective and therefore worthy of investment.
A retrospective analysis of the inpatient logbooks for two government district hospitals in two sub-Saharan African hospitals was performed. Data were extracted and DALYs were calculated based on the diagnosis and procedures undertaken. Estimated costs were obtained based on the patient receiving ideal treatment for their condition rather than actual treatment received.
Total cost per DALY averted was 26 (range 17-66) for Thyolo District Hospital in Malawi and 363 (range 187-881) for Bo District Hospital in Sierra Leone.
This is the first published paper to support the hypothesis that government district hospitals are very cost-effective. The results are within the same range of the US$32.78-223 per DALY averted published for non-governmental hospitals.
如果各国要朝着全民健康覆盖迈进，并实现可持续发展目标以及柳叶刀全球外科委员会设定的2030年有时限目标，撒哈拉以南非洲的地区医院需要投资。此前的研究表明，政府医院可能具有很高的成本效益，因此值得投资。
对撒哈拉以南非洲两家医院的两家政府地区医院的住院登记簿进行回顾性分析。提取数据，并根据诊断和所进行的手术计算伤残调整生命年（DALYs）。估计成本是基于患者接受针对其病情的理想治疗而非实际接受的治疗得出的。
马拉维蒂约洛地区医院每避免一个伤残调整生命年的总成本为26（范围17 - 66），塞拉利昂博区医院为363（范围187 - 881）。
这是第一篇支持政府地区医院具有很高成本效益这一假设的已发表论文。结果与已发表的非政府医院每避免一个伤残调整生命年32.78 - 223美元的范围相同。
