ArticleBMC health services research2022
Maintenance versus replacement of medical equipment: a cost-minimization analysis among district hospitals in Nepal.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Strengthening biomedical engineering systems in sub-Saharan Africa: a repeated cross-sectional assessment of workshop readiness and medical device maintenance in NEST360-supported hospitals.Journal of global health · 2026Article
- Article
- Breaking the "idling dilemma" of donated medical equipment: a TDABC-based analysis of health policy failure and a pathway to reform.Frontiers in public health · 2026Article
- Recent advances in diagnostic technologies for postoperative central nervous system infections: a review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Review
- Improving maintenance efficiency and controlling costs in healthcare institutions through advanced analytical method.Scientific reports · 2025Article
- Global Veterinary Diagnostic Laboratory Equipment Management and Sustainability and Implications for Pandemic Preparedness PrioritiesEmerging infectious diseases · 2023Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAbout half of all medical devices in low- and lower-middle-income countries are currently non-operational because equipment maintenance is lacking. Thus, choosing a cost-efficient equipment maintenance approach has the potential to increase both the quantity and quality of important health services. Between 2010 and 2014 Nepal's Ministry of Health chose two of its development regions to pilot the contracting-out of maintenance services to the private sector. We develop a cost model and employ different data to calculate the cost of this contracted-out scheme. The latter we compare with two additional common approaches to maintenance: in-house maintenance and no maintenance.
methodsWe use invoiced pilot program costs, device depreciation estimates from the literature, and hospital case numbers from Nepal's Health Management Information System. We estimate net-present values for a three-year horizon, incorporating both fixed and operational cost. Operational costs include downtime cost measured as lost revenues due to non-working equipment.
resultsThe contracted-out maintenance scheme shows a strong relative cost performance. Its cost after 3 years amount to 4,501,574 International Dollars Purchasing Power Parity (I$ PPP), only 90% of the cost with no maintenance. The contracted-out scheme incurs 670,288 I$ PPP and 3,765,360 I$ PPP in fixed cost and operational cost, respectively. The cost for replacing broken devices is 1,920,467 I$ PPP lower with maintenance. In addition, after 3 years total cost of contracted-out maintenance is 489,333 I$ PPP (11%) below total cost of decentralized in-house maintenance. After 10 years, contracted-out maintenance saves 2.5 million I$ PPP (18%) compared to no maintenance.
conclusionsWe find that contracted-out maintenance provides cost-efficient medical equipment maintenance in a lower-middle income context. Our findings contrast with studies from high- and upper-middle-income countries, which reflect contexts with more in-house engineering expertise than in our study area. Since the per hospital fixed cost decrease with scheme size, our results lend support to an expansion of contracted-out maintenance to the remaining three development regions in Nepal.
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