Ava YapFollow

Date of Award

January 2018

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Doruk E. Ozgediz

Second Advisor

Reza Yaesoubi


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.


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