东乌干达手术护理提供的成本效益分析——一种社会视角。

A cost-effectiveness analysis of surgical care delivery in Eastern Uganda-a societal perspective.

机构信息

Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.

Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda.

出版信息

BMC Health Serv Res. 2023 Mar 15;23(1):256. doi: 10.1186/s12913-023-09216-x.

DOI:10.1186/s12913-023-09216-x

PMID:36918844

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10015833/

Abstract

BACKGROUND

The mismatch between the global burden of surgical disease and global health funding for surgical illness exacerbates disparities in surgical care access worldwide. Amidst competing priorities, governments need to rationally allocate scarce resources to address local needs. To build an investment case for surgery, economic data on surgical care delivery is needed. This study focuses on femur fractures.

METHODS

This prospective cohort study at Soroti Regional Referral Hospital (SRRH), captured demographic, clinical, and cost data from all surgical inpatients and their caregivers at SRRH from February 2018 through July 2019. We performed descriptive and inferential analyses. We estimated the cost effectiveness of intramedullary nailing relative to traction for femur fractures by using primary data and making extrapolations using regional data.

RESULTS

Among the 546 patients, 111 (20.3%) had femur fractures and their median [IQR] length of hospitalization was 27 days [14, 36 days]. The total societal cost and Quality Adjusted Life Year (QALY) gained was USD 61,748.10 and 78.81 for femur traction and USD 23,809 and 85.47 for intramedullary nailing. Intramedullary nailing was dominant over traction of femur fractures with an Incremental Cost Effectiveness Ratio of USD 5,681.75 per QALY gained.

CONCLUSION

Femur fractures are the most prevalent and most expensive surgical condition at SRRH. Relative to intramedullary nailing, the use of femur traction at SRRH is not cost effective. There is a need to explore and adopt more cost-effective approaches like internal fixation.

摘要

背景

全球外科疾病负担与用于外科疾病的全球卫生资金之间存在不匹配的情况，这加剧了全球范围内外科护理获取方面的差距。在竞争激烈的优先事项中，政府需要合理分配稀缺资源以满足当地需求。为了为外科手术建立投资案例，需要有关于外科护理提供的经济数据。本研究重点关注股骨骨折。

方法

本项在 Soroti 地区转诊医院（SRRH）进行的前瞻性队列研究，从 2018 年 2 月至 2019 年 7 月期间，从 SRRH 的所有外科住院患者及其护理人员那里收集了人口统计学、临床和成本数据。我们进行了描述性和推断性分析。我们使用初级数据来估计髓内钉相对于牵引治疗股骨骨折的成本效果，并使用区域数据进行推断。

结果

在 546 名患者中，有 111 名（20.3%）患有股骨骨折，他们的中位（IQR）住院时间为 27 天[14,36 天]。总的社会成本和获得的质量调整生命年（QALY）分别为 61748.10 美元和 78.81 美元，用于股骨牵引；23809 美元和 85.47 美元，用于髓内钉。髓内钉相对于股骨牵引具有优势，增量成本效果比为每获得一个 QALY 增加 5681.75 美元。