RT Journal
A1 Shillcutt SD, Clarke MG, Kingsnorth AN
T1 COst-effectiveness of groin hernia surgery in the western region of ghana
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD October 1
VO 145
IS 10
SP 954
OP 961
DO 10.1001/archsurg.2010.208
UL http://dx.doi.org/10.1001/archsurg.2010.208
AB Objective 
    To calculate the cost-effectiveness of tension-free inguinal hernia repair with mosquito net mesh in the Western Region of Ghana.Design 
    Prospective study.Setting 
    Four district hospitals in the Western Region of Ghana.Patients 
    A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes.Intervention 
    Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons.Main Outcome Measure 
    Disability-adjusted life-years (DALYs) averted with counterfactual definitions based on precedent and expert opinion.Results 
    All operations were performed as day cases, with 81 of the patients (71.7%) under local anesthesia and few complications. An average of 9.3 (95% confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95% CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95% CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa.Conclusions 
    Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.