title: Surgery and Obstetric Care are Highly Cost-Effective   Interventions in a Sub-Saharan African District Hospital:   A Three-Month Single-Institution Study of Surgical Costs   and Outcomes.
abstract: BACKGROUND
  The Lancet recently sponsored a commission examining the role of surgery in global health. There is a paucity of published information on the cost-effectiveness of surgery in low- and middle-income countries, a key metric in the prioritisation of limited resources.
  
  
  METHODS
  All patients undergoing emergency laparotomy, elective and emergency inguinal hernia repair, elective and emergency caesarean section, amputation, fracture manipulation, or fracture fixation over a 3 months period in a single district African hospital were assessed. World Health Organisation global burden of disease (GBD) methodology was used to calculate the disability-adjusted life years (DALYs) saved for each patient (using global and local life expectancy). Fully loaded costs were calculated for each patient’s care and providing the overall surgical service. Cost-effectiveness was calculated in year 2012 US$ per DALY saved for each procedure and overall.
  
  
  RESULTS
  A total of 428 patients were included, with an overall cost-effectiveness of $10.70 per DALY averted. The cost-effectiveness of individual procedures (global life expectancy) was: Amputation—$17.66; Emergency caesarean section—$7.42; Elective caesarean section—$20.50; Emergency laparotomy—$8.62; Elective hernia repair—$15.26; Emergency hernia repair—$4.36; Fracture/dislocation reduction—$69.03; Fracture/dislocation fixation—$225.89.
  
  
  CONCLUSIONS
  Surgery is a highly cost-effective healthcare measure in the setting of an African district hospital. The presented outcomes demonstrate that surgery is on a par with better-recognised and funded interventions such as HIV anti-retrovirals, malaria prevention and diarrhoea treatment. There are recognised limitations with the GBD methodology used here; however, this remains the best way to investigate the cost-effectiveness of health interventions. This study provides useful information on an, at present, under-studied field.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Roberts
authors.forename: Charlotte
authors.initials: C
authors.lastname: Roberts
authors.forename: Amy
authors.initials: A
authors.lastname: Jamieson
authors.forename: Caris
authors.initials: C
authors.lastname: Grimes
authors.forename: Gemma
authors.initials: G
authors.lastname: Conn
authors.forename: Robert
authors.initials: R
authors.lastname: Bleichrodt
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics*; D004630:Emergencies / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006767:Hospitals, District / Q000191:economics*; D006801:Humans; D009774:Obstetrics / Q000191:economics / Q000379:methods*; D011247:Pregnancy; D013997:Time Factors