Cost-Effectiveness Analysis of Mesh Repair for Inguinal Hernia During a Humanitarian Surgical Mission in Rural Nigeria

Abstract

Background: Humanitarian short-term surgery missions remain under debate, even though the proportion of the burden of surgical diseases around the world that could be treated based on surgery is constantly rising. The primary objective of this study was to prove the cost-effectiveness (CE) of a hernia repair–teaching mission in the rural setting of Nigeria. Methods: We present a CE analysis (CEA) of a 2-week surgery mission performing inguinal hernias with mesh repair according to the Lichtenstein maneuver. All data were collected prospectively. The contribution to the local health system was measured based on the disability-adjusted life years (DALYs). Further on, the CEA was analyzed and separated for surgeons from Nigeria and Europe, respectively. Results: During this mission a total of 107 patients with 123 hernias were treated. An average of 6,61 DALYs per patient were averted. The total costs for the mission team amounted to $8485.26, with a total of $19,210.73 from a societal perspective. Single-procedure costs amounted to $198.87 per patient, with $39.35 per procedure from a patient perspective. The CEA showed $31.04/DALY averted from a societal perspective, $13.71/DALY averted from a provider perspective, and $6.81/DALY averted from a patient perspective. This was well below the threshold of $2790 (gross domestic product per capita). Sensitivity analysis showed robust results. Conclusion: With these results we proved CE and remained about 90 times below the threshold of the gross domestic product per capita.