Cost/DALY averted in a small hospital in Sierra Leone: What is the relative contribution of different services?

Background: A cost-effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability-adjusted life year (DALY) averted by health facilities in the developing world. Methods: We conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83-92). Results: For the 3-month study period, total costs were calculated to be $369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of $32.78. This figure compares favorably to other non-surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted. Conclusions: Surgical treatment of some common pathologies in developing countries may be more cost-effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context-specific, and more research is needed from developing countries to further refine the methodology and analysis.