Yap Ava, Halid Salamatu I, Ukwu Nancy, Laverde Ruth, Park Paul, Klazura Greg, Bryce Emma, Cheung Maija, Marseille Elliot, Ozgediz Doruk, Ameh Emmanuel A
Department of Surgery, University of California San Francisco, San Francisco, California, United States of America.
Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California, United States of America.
PLOS Glob Public Health. 2024 Mar 27;4(3):e0001748. doi: 10.1371/journal.pgph.0001748. eCollection 2024.
The unmet need for pediatric surgery imposes enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of knowledge about the economic impact of improving pediatric surgical infrastructure in SSA inhibits the informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and running two dedicated pediatric operating rooms (ORs) in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of the ORs, which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital's operative registry and prior literature. We adopted an all healthcare payor's perspective including costs incurred by the local healthcare system, the installation (funded by the charity), and patients' families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation and operation were presented. One-way and probabilistic sensitivity analyses were performed. We found that installing and operating two dedicated pediatric ORs averted 538 DALYs and cost $177,527 annually. The ICER of the ORs' installation and operation was $330 per DALY averted (95% uncertainty interval [UI] 315-336) from the all healthcare payor's perspective. This ICER was well under the cost-effectiveness threshold of the country's half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional dedicated pediatric operating rooms in Nigeria with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children's global surgical infrastructure as an economically sound intervention.
全球范围内，小儿外科需求未得到满足带来了巨大的健康和经济后果，主要由撒哈拉以南非洲地区（SSA）承担，该地区儿童几乎占总人口的一半。缺乏对改善SSA小儿外科基础设施的经济影响的了解，阻碍了将有限资源合理分配到最具成本效益的干预措施上，以加强全球儿童外科手术。我们通过构建该机构一年来小儿外科手术交付的决策树模型，比较了在尼日利亚一家已有小儿外科服务的医院安装和运营两个专用小儿手术室（OR）前后的情况，评估了安装和运营这两个手术室的成本效益，这些手术室由慈善机构资助。通过医院的手术登记册和先前的文献确定以避免的残疾调整生命年（DALYs）衡量的健康结果。我们采用了所有医疗支付方的视角，包括当地医疗系统、安装（由慈善机构资助）和患者家庭产生的成本。成本进行了年度化处理，并以2021年美元（$）报告。给出了年度化手术室安装和运营的增量成本效益比（ICERs）。进行了单向和概率敏感性分析。我们发现，安装和运营两个专用小儿手术室可避免538个DALYs，每年成本为177,527美元。从所有医疗支付方的角度来看，手术室安装和运营的ICER为每避免一个DALY 330美元（95%不确定区间[UI] 315 - 336）。这个ICER远低于该国2020年人均国内生产总值一半的成本效益阈值（1043美元），并且在单向和概率敏感性分析中仍然具有成本效益。因此，在尼日利亚已有小儿外科手术能力的情况下，增加安装专用小儿手术室非常具有成本效益，支持将其作为一项经济上合理的干预措施投资于儿童全球外科基础设施。
