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Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan

Author

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  • C Phifer Nicholson
  • Anthony Saxton
  • Katherine Young
  • Emily R Smith
  • Mark G Shrime
  • Jon Fielder
  • Thomas Catena
  • Henry E Rice

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.

Suggested Citation

  • C Phifer Nicholson & Anthony Saxton & Katherine Young & Emily R Smith & Mark G Shrime & Jon Fielder & Thomas Catena & Henry E Rice, 2024. "Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan," PLOS Global Public Health, Public Library of Science, vol. 4(11), pages 1-16, November.
    • Handle: RePEc:plo:pgph00:0003712
    DOI: 10.1371/journal.pgph.0003712
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    References listed on IDEAS

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    1. Erin M Stuckey & Jennifer Stevenson & Katya Galactionova & Amrish Y Baidjoe & Teun Bousema & Wycliffe Odongo & Simon Kariuki & Chris Drakeley & Thomas A Smith & Jonathan Cox & Nakul Chitnis, 2014. "Modeling the Cost Effectiveness of Malaria Control Interventions in the Highlands of Western Kenya," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-11, October.
    2. Laura Bojke & Andrea Manca & Miqdad Asaria & Ronan Mahon & Shijie Ren & Stephen Palmer, 2017. "How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 35(8), pages 767-776, August.
    3. Jonathan Colmer, 2020. "What is the meaning of (statistical) life? Benefit–cost analysis in the time of COVID-19," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 36(Supplemen), pages 56-63.
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