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Cost/DALY Averted in a Small Hospital in Sierra Leone: What Is the Relative Contribution of Different Services?

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Abstract

Background

A cost-effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability-adjusted life year (DALY) averted by health facilities in the developing world.

Methods

We conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83–92).

Results

For the 3-month study period, total costs were calculated to be $369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of $32.78. This figure compares favorably to other non-surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted.

Conclusions

Surgical treatment of some common pathologies in developing countries may be more cost-effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context-specific, and more research is needed from developing countries to further refine the methodology and analysis.

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Author information

Authors and Affiliations

  1. School of Public Health, University of California, Berkeley, California, USA

    Richard A. Gosselin MD, MPH, MSc

  2. Department of Family Medicine, Department of Epidemiology and Biostatistics, Schulich School of Medicine, University of Western Ontario, 245-100 Collip Circle, London, Ont, N6G 4X8, Canada

    Amardeep Thind MD, PhD

  3. Logistician-Administrator, Emergency Hospital, Goderich, Sierra Leone

    Andrea Bellardinelli BA

Authors
  1. Richard A. Gosselin MD, MPH, MSc
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  2. Amardeep Thind MD, PhD
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  3. Andrea Bellardinelli BA
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Corresponding author

Correspondence to Amardeep Thind MD, PhD.

APPENDIX 1: EXAMPLE OF DALY ESTIMATION

APPENDIX 1: EXAMPLE OF DALY ESTIMATION

  • A 15-year-old male with peritonitis who undergoes successful surgery (>95% mortality without treatment, >95% chance of permanent cure) 36.80 (YLL value for males aged 15) × 1.0 × 1.0 = 36.80 DALYs averted by surgery.

  • A 5-year-old female successfully treated for very severe anemia/malaria (>95% mortality without treatment, <50% chance of permanent cure of the condition)

  • 36.59 (YLL value for females aged 5) × 1.0 × 0.3 = 11 DALYs averted by treatment.

  • A 20-year-old male who survives a road traffic accident with a unilateral below-knee amputation (<95% mortality without treatment, >95% chance of permanent disability, with weight of 0.281) 35.02 × 0.7 × 1.0 × 0.281 = 6.9 DALYs averted by surgery.

The above calculations were undertaken to estimate the DALYs averted for all patients seen during the 3-month period. Calculations were done individually for all inpatients. Because patients keep their own outpatient charts, the available data from OPD are less explicit, but age, sex, diagnosis, and treatment were retrievable from the OPD log books. Manual reduction of sedated patients with incarcerated inguinal hernias, for example, was successful 39 times. These patients had a mean age of 37 years, and we estimate that >50% would eventually have died without any treatment and that the treatment is successful (i.e., definitive) in <50% of the cases. DALYs were calculated as follows: 39 × 26 (YLL value for males aged 37) × 0.7 × 0.3 = 213 DALYs averted. The same principles were applied for fractures treated in OPD: 338 patients, of mean age 24 years, with the assumption that 10% of these would have a greater than 50% chance of some form of permanent disability. This averted 785 DALYs, which for 338 patients of mean age 24 is probably an overly conservative estimate.

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Gosselin, R.A., Thind, A. & Bellardinelli, A. Cost/DALY Averted in a Small Hospital in Sierra Leone: What Is the Relative Contribution of Different Services?. World J. Surg. 30, 505–511 (2006). https://doi.org/10.1007/s00268-005-0609-5

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  • DOI: https://doi.org/10.1007/s00268-005-0609-5

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