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

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.

Direct Cost of Illness for Spinal Cord Injury: A Systematic Review

“…A total of 21 studies reported the mean cost of hospital acute care in 8 countries. The lowest costs were found in Nigeria, 41 Tanzania, 44 China, 39 and Taiwan 42 , 43 ($290 to $4,860). A study from Mexico reported the mean cost of acute care for complete cervical SCI to be $29,940.…”

“…Most studies originated in North America (the U.S.: 15 studies, 15 - 29 and Canada: 7 30 - 36 ); and the rest were conducted in Australia, 37 , 38 China, 39 Mexico, 40 Nigeria, 41 Taiwan, 42 , 43 and Tanzania. 44 Sample sizes ranged from 34 to 15,510, and settings varied from hospital-based to nationwide. The methodologies, cost perspectives, and sources of cost data varied considerably among studies; with 13 studies took a top-down approach, and the rest including most of the U.S. studies used bottom-up approaches.…”

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

“…They will be used in a separate study to develop evidence-based recommendations for economic evaluations in spine surgery. Finally, a total of 130 clinical cost-effectiveness studies were included 24–153…”

Secondary damage management of acute traumatic spinal cord injury in low and middle-income countries: A survey on a global scale (Part III)

“…We recommend public policies that implement universal health care coverage ( Kruk et al., 2018 ). Actually, the results of recent cost-effective studies suggest that surgery-related costs may be offset by a reduction in disability, and LMICs governments should be encouraged to conduct further spine trauma management and treatment cost-effectiveness analyses ( Lessing et al., 2022 ).…”