Cost-effectiveness of groin hernia surgery in the Western Region of Ghana.
OBJECTIVE
To calculate the cost-effectiveness of tension-free inguinal hernia repair with mosquito net mesh in the Western Region of Ghana.


METHODS
Prospective study.


METHODS
Four district hospitals in the Western Region of Ghana.


METHODS
A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes.


METHODS
Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons. Main Outcome Measure Disability-adjusted life-years (DALYs) averted with counterfactual definitions based on precedent and expert opinion.


RESULTS
All operations were performed as day cases, with 81 of the patients (71.7%) under local anesthesia and few complications. An average of 9.3 (95% confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95% CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95% CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa.


CONCLUSIONS
Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.
Shillcutt
Samuel D
SD
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Clarke
Michael G
MG
Kingsnorth
Andrew N
AN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D013526:Surgical Mesh / Q000191:economics*; D055815:Young Adult