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dc.contributor.authorLessing, Noah L.
dc.contributor.authorZuckerman, Scott L.
dc.contributor.authorLazaro, Albert
dc.contributor.authorLeech, Ashley A.
dc.contributor.authorLeidinger, Andreas
dc.contributor.authorRutabasibwa, Nicephorus
dc.contributor.authorShabani, Hamisi K.
dc.contributor.authorMangat, Halinder S.
dc.contributor.authorHärtl, Roger
dc.date.accessioned2020-09-01T14:46:32Z
dc.date.available2020-09-01T14:46:32Z
dc.date.issued2020-01-01
dc.identifier.urihttp://hdl.handle.net/10713/13603
dc.description.abstractStudy 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. © The Author(s) 2020.en_US
dc.description.urihttps://doi.org/10.1177/2192568220944888en_US
dc.language.isoen_USen_US
dc.publisherSAGE Publications Inc.en_US
dc.relation.ispartofGlobal Spine Journalen_US
dc.subjectEast Africaen_US
dc.subjectglobal neurosurgeryen_US
dc.subjectlow-middle income countriesen_US
dc.subjectneurotraumaen_US
dc.subjectTanzaniaen_US
dc.subjecttraumatic spinal cord injuryen_US
dc.titleCost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Centeren_US
dc.typeArticleen_US
dc.identifier.doi10.1177/2192568220944888
dc.identifier.scopusidSCOPUS_ID:85089502671


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