Jihad Abdelgadir1, Tu Tran2, Alex Muhindo3, Doomwin Obiga3, John Mukasa3, Hussein Ssenyonjo3, Michael Muhumza3, Joel Kiryabwire3, Michael M Haglund4, Frank A Sloan5. 1. Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA. 2. Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA. 3. Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda. 4. 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. 5. Duke University Global Health Institute, Durham, North Carolina, USA. Electronic address: fsloan@duke.edu.
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.
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: Benjamin J Kuo; Silvia D Vaca; Joao Ricardo Nickenig Vissoci; Catherine A Staton; Linda Xu; Michael Muhumuza; Hussein Ssenyonjo; John Mukasa; Joel Kiryabwire; Lydia Nanjula; Christine Muhumuza; Henry E Rice; Gerald A Grant; Michael M Haglund Journal: PLoS One Date: 2017-10-31 Impact factor: 3.240
Authors: Silvia D Vaca; Benjamin J Kuo; Joao Ricardo Nickenig Vissoci; Catherine A Staton; Linda W Xu; Michael Muhumuza; Hussein Ssenyonjo; John Mukasa; Joel Kiryabwire; Henry E Rice; Gerald A Grant; Michael M Haglund Journal: Neurosurgery Date: 2019-01-01 Impact factor: 4.654
Authors: Chinemerem Nwosu; Charis A Spears; Charles Pate; Deborah T Gold; Gary Bennett; Michael Haglund; Anthony Fuller Journal: Ann Glob Health Date: 2020-10-06 Impact factor: 2.462