ArticleWorld journal of surgery2016
Surgery and Obstetric Care are Highly Cost-Effective Interventions in a Sub-Saharan African District Hospital: A Three-Month Single-Institution Study of Surgical Costs and Outcomes.
Article in World journal of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Cost-effectiveness of surgical interventions in low-income and middle-income countries: a systematic review and critical analysis of recent evidence.BMJ global health · 2024Pooled it
- A Systematic Review of Orthopedic Global Outreach Efforts Based on WHO-CHOICE Thresholds.Hand clinics · 2019Pooled it
- What a mesh: a call for better science and regulatory oversight.The British journal of surgery · 2026Article
- The Burden of Lower Limb Deformities in Low- and Lower-Middle-Income Countries: A Scoping Review.Journal of the Pediatric Orthopaedic Society of North America · 2026Review
- Evaluating Access Improving Interventions: An Economic Evaluation of Surgical Task-Shifting for C-Sections in Sierra Leone.Applied health economics and health policy · 2025Article
- Who pays for surgical care in the global south? A narrative review.PLOS global public health · 2025Review
- First referral hospitals in low- and middle-income countries: the need for a renewed focus.Health policy and planning · 2024Review
- A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century.BMC pregnancy and childbirth · 2022Article
- Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center.Global spine journal · 2022Article
- Postoperative Complications and Risk of Mortality after Laparotomy in a Resource-Limited Setting.The Journal of surgical research · 2021Observational
- Article
- Underutilization of Operative Capacity at the District Hospital Level in a Resource-Limited Setting.The Journal of surgical research · 2021Observational
- The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia.Global health, science and practice · 2019Article
- A one stop shop for cost-effectiveness evidence? Recommendations for improving Disease Control Priorities.Cost effectiveness and resource allocation : C/E · 2019Article
- Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis.World journal of surgery · 2018Article
- Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing.BJS open · 2018Article
- A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries.Acta obstetricia et gynecologica Scandinavica · 2017Article
- Cesarean section in sub-Saharan Africa.Maternal health, neonatology and perinatology · 2016Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Lancet recently sponsored a commission examining the role of surgery in global health. There is a paucity of published information on the cost-effectiveness of surgery in low- and middle-income countries, a key metric in the prioritisation of limited resources.
methodsAll patients undergoing emergency laparotomy, elective and emergency inguinal hernia repair, elective and emergency caesarean section, amputation, fracture manipulation, or fracture fixation over a 3 months period in a single district African hospital were assessed. World Health Organisation global burden of disease (GBD) methodology was used to calculate the disability-adjusted life years (DALYs) saved for each patient (using global and local life expectancy). Fully loaded costs were calculated for each patient’s care and providing the overall surgical service. Cost-effectiveness was calculated in year 2012 US$ per DALY saved for each procedure and overall.
resultsA total of 428 patients were included, with an overall cost-effectiveness of $10.70 per DALY averted. The cost-effectiveness of individual procedures (global life expectancy) was: Amputation—$17.66; Emergency caesarean section—$7.42; Elective caesarean section—$20.50; Emergency laparotomy—$8.62; Elective hernia repair—$15.26; Emergency hernia repair—$4.36; Fracture/dislocation reduction—$69.03; Fracture/dislocation fixation—$225.89.
conclusionsSurgery is a highly cost-effective healthcare measure in the setting of an African district hospital. The presented outcomes demonstrate that surgery is on a par with better-recognised and funded interventions such as HIV anti-retrovirals, malaria prevention and diarrhoea treatment. There are recognised limitations with the GBD methodology used here; however, this remains the best way to investigate the cost-effectiveness of health interventions. This study provides useful information on an, at present, under-studied field.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.