Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center

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Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center


JournalGlobal Spine Journal
Publication date – Aug – 2020
Authors – Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income CounNoah L. Lessing, BS, Scott L. Zuckerman, MD, MPH, Albert Lazaro, MD, Ashley A. Leech, PhD, MS, Andreas Leidinger, MD, Nicephorus Rutabasibwa, MD, Hamisi K. Shabani, MD, PhD, Halinder S. Mangat, MD, Roger Härtl, MD
KeywordsEast Africa, Global neurosurgery, low-middle income countries, Neurotrauma, Tanzania, traumatic spinal cord injury
Open access – Yes
SpecialityNeurosurgery, Trauma surgery
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on August 31, 2020 at 1:31 am
Abstract:

Study Design:
Retrospective cost-effectiveness analysis.

Objectives:
While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting.

Methods:
At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life).

Results:
A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences.

Conclusions:
This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care.

OSI Number – 20642
PMID – 32799677

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