Thet Lwin Zin Min, Forsberg Birger, Keel George, Beard Jessica H, Amoako Joachim, Ohene-Yeboah Michael, Tabiri Stephen, Löfgren Jenny
The Swedish Institute for Health Economics, Lund, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
PLOS Glob Public Health. 2022 Apr 4;2(4):e0000270. doi: 10.1371/journal.pgph.0000270. eCollection 2022.
An unmet need for inguinal hernia repair is significant in Ghana where the number of specialist general surgeons is extremely limited. While surgical task sharing with medical doctors without formal specialist training in surgery has been adopted for inguinal hernia repair in Ghana, no prior research has been conducted on the long-term costs and health outcomes associated with expanding operations to repair all inguinal hernias among adult males in Ghana. The study aimed to estimate cost-effectiveness of elective open mesh repair performed by medical doctors and surgeons for adult males with primary inguinal hernia compared to no treatment in Ghana and to project costs and health gains associated with expanding operation services through task sharing between medical doctors and surgeons. The study analysis adopted a healthcare system perspective. A Markov model was constructed to assess 10-year differences in costs and outcomes between operations conducted by medical doctors or surgeons and no treatment. A 10-year budget impact analysis on service expansion for groin hernia repair through increasing task sharing between the providers was conducted. Incremental cost-effectiveness ratios for medical doctors and surgeons were USD 120 and USD 129 respectively per disability-adjusted life year (DALY) averted compared to no treatment, which are below the estimated threshold value for cost-effectiveness in Ghana of USD 371-491. Repairing all inguinal hernias (1.4 million) through task sharing between the providers in the same timeframe is estimated to cost USD 194 million. Total health gains of 1.5 million DALYs averted are expected. Inguinal hernia repair is cost-effective regardless of the type of surgical provider. Scaling up of inguinal hernia repair is worthwhile, with the potential to substantially reduce the disease burden in the country.
在加纳，腹股沟疝修补存在着巨大的未满足需求，因为该国普通外科专家的数量极为有限。虽然加纳已采用让未接受过正规外科专科培训的医生分担腹股沟疝修补手术任务的做法，但此前尚未对扩大手术范围以修复加纳成年男性所有腹股沟疝的长期成本和健康结果进行研究。该研究旨在评估在加纳，由医生和外科医生进行的择期开放式网片修补术与不治疗相比，对原发性腹股沟疝成年男性的成本效益，并预测通过医生和外科医生之间的任务分担扩大手术服务所带来的成本和健康收益。该研究分析采用了医疗保健系统的视角。构建了一个马尔可夫模型，以评估医生或外科医生进行的手术与不治疗之间在成本和结果方面的10年差异。对通过增加提供者之间的任务分担来扩大腹股沟疝修补服务进行了为期10年的预算影响分析。与不治疗相比，医生和外科医生的增量成本效益比分别为每避免一个伤残调整生命年（DALY）120美元和129美元，低于加纳估计的成本效益阈值371 - 491美元。在同一时间范围内，通过提供者之间的任务分担修复所有腹股沟疝（140万例）估计成本为1.94亿美元。预计总共可避免150万个DALY的健康收益。无论手术提供者的类型如何，腹股沟疝修补都是具有成本效益的。扩大腹股沟疝修补规模是值得的，有可能大幅减轻该国的疾病负担。
