title: Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.
abstract: BACKGROUND
  Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting.
  
  
  METHODS
  Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention.
  
  
  RESULTS
  Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios.
  
  
  CONCLUSIONS
  Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.
authors.affiliation: Department of Surgery, University of British Columbia, Room 3100, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada, gareth.eeson@gmail.com.
authors.forename: Gareth
authors.initials: G
authors.lastname: Eeson
authors.forename: Doreen
authors.initials: D
authors.lastname: Birabwa-Male
authors.forename: Mark
authors.initials: M
authors.lastname: Pennington
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Blair
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003906:Developing Countries / Q000191:economics*; D017558:Elective Surgical Procedures / Q000191:economics; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000151:congenital / Q000191:economics* / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics*; D006801:Humans; D011336:Probability; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D014454:Uganda