Department of Surgery, Division of Trauma and Surgical Critical Care, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Swedish Institute for Health Economics, Stockholm, Sweden.
Value Health Reg Issues. 2022 Nov;32:31-38. doi: 10.1016/j.vhri.2022.07.004. Epub 2022 Aug 29.
Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting. This study has aimed to evaluate and compare the cost-effectiveness of mesh repair performed by Ghanaian surgeons and medical doctors (MDs) following a standardized training program.
This cost-effectiveness analysis included data for 223 operations on adult men with primary reducible inguinal hernia. Cost per surgery was calculated from the healthcare system perspective. Disability weights were calculated using pre- and postoperative pain scores and benchmarks from the Global Burden of Disease Study 2017.
The mean cost/disability-adjusted life-year (DALY) averted in the surgeon group was 444.9 United States dollars (USD) (95% confidence interval [CI] 221.2-668.5) and 278.9 USD (95% CI 199.3-358.5) in the MD group (P = .168), indicating that the operation is very cost-effective when performed by both providers. The incremental cost/DALY averted showed that task-sharing with MDs is also very cost-effective (95% bootstrap CI -436.7 to 454.9). The analysis found that increasing provider salaries is cost-effective if productivity remains high. When only symptomatic cases were analyzed, the mean cost/DALY averted reduced to 232.0 USD (95% CI 17.1-446.8) for the surgeon group and 129.7 USD (95% CI 79.6-179.8) for the MD group (P = .348), and the incremental cost/DALY averted increased by 45% but remained robust.
Elective inguinal hernia repair with mesh performed by Ghanaian surgeons and MDs is a low-cost procedure and very cost-effective in the context of the study. To maximize cost-effectiveness, symptomatic patients should be prioritized over asymptomatic patients and a high level of productivity should be maintained.
任务分担是指在不同培训水平的提供者之间实际分担任务。据我们所知，在资源匮乏的环境下，尚未有研究评估疝修补术的外科任务分担的成本效益。本研究旨在评估和比较加纳外科医生和医生（MD）在标准化培训计划后进行的网片修补术的成本效益。
本成本效益分析纳入了 223 例成年男性原发性可复性腹股沟疝手术的数据。从医疗保健系统的角度计算了每次手术的成本。使用术前和术后疼痛评分以及 2017 年全球疾病负担研究的基准值计算残疾权重。
外科医生组的平均成本/残疾调整生命年（DALY）节省为 444.9 美元（95%置信区间[CI] 221.2-668.5），而 MD 组为 278.9 美元（95%CI 199.3-358.5）（P=.168），表明这两种手术提供者都具有很高的成本效益。增量成本/DALY 节省表明，与 MD 进行任务分担也具有很高的成本效益（95%自举 CI -436.7 至 454.9）。分析发现，如果保持高生产力，增加提供者的工资是具有成本效益的。当仅分析有症状的病例时，外科医生组的平均成本/DALY 节省减少到 232.0 美元（95%CI 17.1-446.8），MD 组为 129.7 美元（95%CI 79.6-179.8）（P=.348），增量成本/DALY 节省增加了 45%，但仍然稳健。
加纳外科医生和 MD 进行的网片修补术是一种低成本的手术，在研究背景下具有很高的成本效益。为了实现最大的成本效益，应优先考虑有症状的患者，而不是无症状的患者，并且应保持较高的生产力水平。
