title: The cost-effectiveness of orthopaedic clinical officers in Malawi.
abstract: BACKGROUND
  In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program.
  
  
  METHODS
  Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted.
  
  
  RESULTS
  The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58-207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the 'economically active' demographic of ages 15-74 years.
  
  
  CONCLUSIONS
  Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.
authors.affiliation: Global Surgery Associate, Kings Centre for Global Health, Kings College London and King's Health Partners, London, UK carisgrimes@doctors.org.uk.
authors.forename: Caris E
authors.initials: CE
authors.lastname: Grimes
authors.affiliation: Professor Orthopaedics and Head of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; Clinical Director, OCO Training Programme, Malawi College of Health Sciences, Blantyre Campus, Blantyre, Malawi; Adjunct Professor, School of Medicine, Flinders University, Adelaide, South Australia.
authors.forename: Nyengo C
authors.initials: NC
authors.lastname: Mkandawire
authors.affiliation: Medical Student, St George's, University of London, London, UK.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Billingsley
authors.affiliation: Principal Instructor for Malawi Orthopaedic Clinical Officer Program, Malawi College of Health Sciences, Blantyre Campus, Blantyre, Malawi.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ngulube
authors.affiliation: Senior Associate, Johns Hopkins Bloomberg School of Public Health, Clinical Professor of Orthopaedics, Georgetown School of Medicine, Washington, DC, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Cobey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000488:Allied Health Personnel / Q000191:economics / Q000193:education; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D004501:Education, Medical / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000191:economics* / Q000706:statistics & numerical data; D009985:Orthopedics / Q000191:economics* / Q000193:education / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D055815:Young Adult
keywords: Cost-effectiveness; Orthopaedic clinical officers; Task shifting