Nicholson C Phifer, Saxton Anthony, Young Katherine, Smith Emily R, Shrime Mark G, Fielder Jon, Catena Thomas, Rice Henry E
Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America.
Mother of Mercy-Gidel Hospital, Gidel, Sudan.
PLOS Glob Public Health. 2024 Nov 4;4(11):e0003712. doi: 10.1371/journal.pgph.0003712. eCollection 2024.
The delivery of healthcare in conflict-affected regions places tremendous strains to health systems, and the economic value of surgical care in conflict settings remains poorly understood. Our aims were to evaluate the cost-effectiveness, societal economic benefits, and return on investment (ROI) for surgical care in a conflict-affected region in Sudan. We conducted a retrospective study of surgical care from January to December 2022 at the Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan, a semi-autonomous region characterized by chronic and cyclical conflict. We collected data on all patients undergoing surgical procedures (n = 3016), including age, condition, and procedure. We used the MMH budget and financial statements to measure direct medical and non-medical expenditures (costs) for care. We estimated the proportion of expenditures for surgical care through a survey of surgical vs non-surgical beds. The benefits of care were calculated as averted disability-adjusted life-years (DALYa) based on predicted outcomes for the most common 81% of procedures, and then extrapolated to the overall cohort. We calculated the average cost-effectiveness ratio (CER) of care. The societal economic benefits of surgical care were modeled using a human capital approach, and we performed a ROI analysis. Uncertainty was estimated using sensitivity analysis. We found that the CER for all surgical care was $72.54/DALYa. This CER is far less than the gross domestic product per capita in the comparator economy of South Sudan ($585), qualifying it as very cost-effective by World Health Organization standards. The total societal economic impact of surgical care was $9,124,686, yielding a greater than 14:1 ROI ratio. Sensitivity analysis confirmed confidence in all output models. Surgical care in this conflict-affected region of Sudan is very cost-effective, provides substantial societal economic benefits, and a high return on investment.
在受冲突影响的地区提供医疗保健给卫生系统带来了巨大压力，而冲突环境下外科护理的经济价值仍未得到充分理解。我们的目标是评估苏丹一个受冲突影响地区外科护理的成本效益、社会经济效益和投资回报率（ROI）。我们对苏丹努巴山区慈悲之母 - 吉德尔医院（MMH）2022年1月至12月的外科护理进行了回顾性研究，该地区是一个半自治区，长期遭受周期性冲突。我们收集了所有接受外科手术患者（n = 3016）的数据，包括年龄、病情和手术。我们使用MMH的预算和财务报表来衡量护理的直接医疗和非医疗支出（成本）。我们通过对外科病床与非外科病床的调查来估计外科护理支出的比例。护理的效益根据最常见的81%手术的预测结果计算为避免的残疾调整生命年（DALYa），然后推算至整个队列。我们计算了护理的平均成本效益比（CER）。外科护理的社会经济效益采用人力资本方法进行建模，并进行了投资回报率分析。使用敏感性分析估计不确定性。我们发现所有外科护理的CER为72.54美元/DALYa。这个CER远低于南苏丹对照经济体的人均国内生产总值（585美元），按照世界卫生组织的标准，这使其具有很高的成本效益。外科护理的总社会经济影响为9,124,686美元，投资回报率大于14:1。敏感性分析证实了对所有产出模型的信心。在苏丹这个受冲突影响的地区，外科护理具有很高的成本效益，能带来巨大的社会经济效益和高投资回报率。
