ArticlePLOS global public health2024
Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan.
Article in PLOS global public health, 2024. 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.
- Quantifying multilateral contributions to surgical system development in low- and middle-income countries: an analysis of trends and opportunities.BMJ global health · 2026Article
- Surgically avertable deaths in a rural Ethiopian community: a verbal autopsy study.BMC surgery · 2026Article
- Estimating the global macroeconomic impact of colorectal cancer: evidence from Global Burden of Disease 2021 and Value of a Statistical Life Year framework.International journal of surgery (London, England) · 2026Article
- Financing surgery in LMICs: building sustainable and equitable systems for universal surgical access - a narrative review.BMC surgery · 2025Review
- Improvised chest tube drainage: A practical approach to thoracic emergencies in humanitarian crises.Surgery in practice and science · 2025Article
- Breaking ground: insights from a WHO-approved surgical mission amid Sudan's healthcare collapse.Frontiers in public health · 2025Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The delivery of healthcare in conflict-affected regions places tremendous strains to health systems, and the economic value of surgical care in conflict settings remains poorly understood. Our aims were to evaluate the cost-effectiveness, societal economic benefits, and return on investment (ROI) for surgical care in a conflict-affected region in Sudan. We conducted a retrospective study of surgical care from January to December 2022 at the Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan, a semi-autonomous region characterized by chronic and cyclical conflict. We collected data on all patients undergoing surgical procedures (n = 3016), including age, condition, and procedure. We used the MMH budget and financial statements to measure direct medical and non-medical expenditures (costs) for care. We estimated the proportion of expenditures for surgical care through a survey of surgical vs non-surgical beds. The benefits of care were calculated as averted disability-adjusted life-years (DALYa) based on predicted outcomes for the most common 81% of procedures, and then extrapolated to the overall cohort. We calculated the average cost-effectiveness ratio (CER) of care. The societal economic benefits of surgical care were modeled using a human capital approach, and we performed a ROI analysis. Uncertainty was estimated using sensitivity analysis. We found that the CER for all surgical care was $72.54/DALYa. This CER is far less than the gross domestic product per capita in the comparator economy of South Sudan ($585), qualifying it as very cost-effective by World Health Organization standards. The total societal economic impact of surgical care was $9,124,686, yielding a greater than 14:1 ROI ratio. Sensitivity analysis confirmed confidence in all output models. Surgical care in this conflict-affected region of Sudan is very cost-effective, provides substantial societal economic benefits, and a high return on investment.
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Registered trials
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