title: The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania.
abstract: Femoral shaft fractures are one of the most common injuries seen by surgeons in low- and middle-income countries (LMICs). Surgical repair in LMICs is often dismissed as not being cost-effective or unsafe, though little evidence exists to support this notion. Therefore, the goal of this study is to determine the cost of intramedullary nailing of femoral shaft fractures in Tanzania.
  
  
  
  We used micro-costing methods to estimate the fixed and variable costs of intramedullary nailing of femoral shaft fractures. Variable costs assessed included medical personnel costs, ward personnel costs, implants, medications, and single-use supplies. Fixed costs included costs for surgical instruments and administrative and ancillary staff.
  
  
  
  46 adult femoral shaft fracture patients admitted to Muhimbili Orthopaedic Institute between June and September 2014 were enrolled and treated with intramedullary fixation. The total cost per patient was $530.87 (SD $129.99). The mean variable cost per patient was $419.87 (SD $129.99), the largest portion coming from ward personnel $144.47 (SD $123.30), followed by implant $134.10 (SD $15.00) medical personnel $106.86 (SD $28.18), and medications/supplies $30.05 (SD $12.28). The mean fixed cost per patient was $111.00, consisting of support staff, $103.50, and surgical instruments, $7.50.
  
  
  
  Our study provides empirical information on the variable and fixed costs of intramedullary nailing of femoral shaft fractures in LMICs. Importantly, the lack of surgical capacity was the primary driver of the largest cost for this procedure, preoperative ward personnel time. Our results provide the cost data for a formal cost-effectiveness analysis on this intervention.
authors.affiliation: Institute for Global Orthopedics and Traumatology, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA. erik.kramer@yale.edu.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Kramer
authors.affiliation: Institute for Global Orthopedics and Traumatology, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Shearer
authors.affiliation: Health Strategies International, Oakland, CA, USA.|Global Health Economics Consortium, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Marseille
authors.affiliation: Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
authors.forename: Billy
authors.initials: B
authors.lastname: Haonga
authors.affiliation: Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ngahyoma
authors.affiliation: Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
authors.forename: Edmund
authors.initials: E
authors.lastname: Eliezer
authors.affiliation: Institute for Global Orthopedics and Traumatology, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.|Global Health Economics Consortium, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Saam
authors.initials: S
authors.lastname: Morshed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D003362:Cost-Benefit Analysis; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D013636:Tanzania; D055815:Young Adult