Author

Ava YapFollow

Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Doruk E. Ozgediz

Second Advisor

Reza Yaesoubi

Abstract

This study examines the cost-effectiveness of constructing a dedicated pediatric operating room (OR) in Uganda, a country where access to surgical care is limited to 4 pediatric surgeons serving a population of over 20 million children under 15 years of age.

A decision tree model projected the cost and disability-adjusted life-years (DALY) averted by a Ugandan pediatric OR. OR cost data were collected by obtaining equipment price lists, anesthetic and operative reports, government salary scales. A patient family survey was administered over 6 months to collect out-of-pocket (OOP) costs. The OR case-log, pediatric surgical ward database and literature review informed patients’ outcomes. A Monte Carlo simulation modelled the incremental cost-effectiveness ratio (ICER) of a pediatric OR. One-way and probabilistic sensitivity analysis was performed to assess parameter uncertainty. Net monetary benefit was calculated using the value of a statistical life approach.

Our model of a dedicated pediatric OR averted a total of 3004 DALYs in a year (95% uncertainty interval or UI 2,928 -3,080) and costed $240,526 (95% UI 236,264-244,789) to install and maintain for a year. The pediatric operating room had an ICER of $80.06 per DALY averted (95% UI 77.77-80.82), or $4,987.87 (95% UI 4,845.08-5,035.08) per life saved based on the country's average life expectancy in 2015. These values were well within the WHO guidelines of the cost-effectiveness threshold. The net economic benefit was $2,392,338 in a year, or $6,428 per patient. The model remained robust with one-way and probabilistic sensitivity analyses.

These findings support the construction and maintenance of a pediatric operating room in Uganda as a cost-effective, worthwhile investment, endorsing future decisions to enhance pediatric surgical capacity in the resource-limited settings of Sub-Saharan Africa.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/27/2019

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