Cost-effectiveness of groin hernia surgery in the western region of Ghana

Objective: To calculate the cost-effectiveness of tensionfree inguinal hernia repair with mosquito net mesh in the Western Region of Ghana. Design: Prospective study. Setting: Four district hospitals in the Western Region of Ghana. Patients: A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes. Intervention: Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons. Main Outcome Measure: Disability-adjusted lifeyears (DALYs) averted with counterfactual definitions based on precedent and expert opinion. Results: All operations were performed as day cases, with 81 of the patients (71.7%) under local anesthesia and few complications. An average of 9.3 (95% confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95% CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95% CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa. Conclusions: Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.