title: Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.
abstract: BACKGROUND
  There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning.
  
  
  METHODS
  In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda).
  
  
  RESULTS
  During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%).
  
  
  CONCLUSIONS
  This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.
authors.affiliation: Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA.
authors.forename: Jihad
authors.initials: J
authors.lastname: Abdelgadir
authors.affiliation: Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA.
authors.forename: Tu
authors.initials: T
authors.lastname: Tran
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Muhindo
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Doomwin
authors.initials: D
authors.lastname: Obiga
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: John
authors.initials: J
authors.lastname: Mukasa
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Hussein
authors.initials: H
authors.lastname: Ssenyonjo
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Michael
authors.initials: M
authors.lastname: Muhumza
authors.affiliation: Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors.forename: Joel
authors.initials: J
authors.lastname: Kiryabwire
authors.affiliation: Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Haglund
authors.affiliation: Duke University Global Health Institute, Durham, North Carolina, USA. Electronic address: fsloan@duke.edu.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Sloan
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis / Q000639:trends; D005260:Female; D015276:Health Care Rationing / Q000191:economics* / Q000639:trends; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000191:economics / Q000639:trends; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics* / Q000193:education / Q000639:trends; D011203:Poverty / Q000191:economics* / Q000639:trends; D014454:Uganda; D055815:Young Adult
keywords: Cost analysis; Global surgery; Microcosting; Neurosurgery