title: Cost-Effectiveness of Two Government District Hospitals in Sub-Saharan Africa.
abstract: District hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Previous studies have suggested that government hospitals are likely to be highly cost-effective and therefore worthy of investment.
  
  
  
  A retrospective analysis of the inpatient logbooks for two government district hospitals in two sub-Saharan African hospitals was performed. Data were extracted and DALYs were calculated based on the diagnosis and procedures undertaken. Estimated costs were obtained based on the patient receiving ideal treatment for their condition rather than actual treatment received.
  
  
  
  Total cost per DALY averted was 26 (range 17-66) for Thyolo District Hospital in Malawi and 363 (range 187-881) for Bo District Hospital in Sierra Leone.
  
  
  
  This is the first published paper to support the hypothesis that government district hospitals are very cost-effective. The results are within the same range of the US$32.78-223 per DALY averted published for non-governmental hospitals.
authors.affiliation: King's Centre for Global Health and Health Partnerships, King's College London and King's Health Partners, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK. caris.grimes@kcl.ac.uk.|Medway NHS Foundation Trust, Gillingham, Kent, UK. caris.grimes@kcl.ac.uk.
authors.forename: Caris E
authors.initials: CE
authors.lastname: Grimes
authors.affiliation: PGMC, Croydon University Hospital, London Road, London, CR7 7YE, UK.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Law
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Dare
authors.affiliation: PGMC, Croydon University Hospital, London Road, London, CR7 7YE, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Day
authors.affiliation: , London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Reshamwalla
authors.affiliation: Thyolo District Hospital, Thyolo, Malawi.
authors.forename: Michael
authors.initials: M
authors.lastname: Murowa
authors.affiliation: Bo District Hospital, Bo, Sierra Leone.|Connaught Hospital, Freetown, Sierra Leone.
authors.forename: Peter M
authors.initials: PM
authors.lastname: George
authors.affiliation: Connaught Hospital, Freetown, Sierra Leone.|Department of Surgery, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi.|School of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Nyengo C
authors.initials: NC
authors.lastname: Mkandawire
authors.affiliation: King's Centre for Global Health and Health Partnerships, King's College London and King's Health Partners, London, UK.|King's College London, London, UK.
authors.forename: Andrew J M
authors.initials: AJM
authors.lastname: Leather
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Christopher B D
authors.initials: CBD
authors.lastname: Lavy
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006767:Hospitals, District / Q000191:economics*; D006801:Humans; D008295:Malawi; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D012807:Sierra Leone