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Challenges of costing a surgical procedure: a case study on hysterectomy

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dc.contributor.author Ranasinghe, S. W.
dc.contributor.author Liyanage, L.
dc.contributor.author Peiris, R.
dc.contributor.author Bandaranayake, H.
dc.contributor.author Ekanayake, C. D.
dc.contributor.author Pathmeswaran, A.
dc.contributor.author Kularatna, S.
dc.contributor.author Wijesinghe, P. S.
dc.date.accessioned 2019-02-11T09:36:43Z
dc.date.available 2019-02-11T09:36:43Z
dc.date.issued 2018
dc.identifier.citation Sri Lanka Journal of Obstetrics & Gynaecology 2018; Vol. 40 (suppl. 1): p. 21 en_US
dc.identifier.issn 2279-1655
dc.identifier.uri http://repository.kln.ac.lk/handle/123456789/19884
dc.description Oral presentations Abstract, 51st Annual Scientific Congress, Sri Lanka College of Obstetricians & Gynaecologists,11th -12th August 2018 Sri Lanka Foundation, Colombo en_US
dc.description.abstract INTRODUCTION: It is vital to enquire in to cost of healthcare to ensure that maximum value for money is obtained with available resources. However, there is a dearth of information on cost of healthcare in lower-middle income countries. Our aim was to study the costs for three routes of hysterectomy in benign uterine conditions; total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHOD: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. Patients were recruited from a district general hospital (Mannar) and an urban tertiary care hospital (Ragama). The total cost incurred during pre-operative, operative, post-operative periods and convalescence included direct costs of labour, equipment, investigations, medications and utilities. Indirect costs included of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour costs and top down micro-costing was used for utilities. RESULTS: The median direct cost [(interquartile range), number] of TAH was Rs. 43054 [(41604 - 46243), n=24] versus Rs. 39430 [(37690 - 43054), n=25] (Mann-Whitney U test, p<0.01), NDVH was Rs. 40590 [(36965 - 44793), n=23] versus Rs.40155 [(36676 - 43779), n=26] (Mann-Whitney U test, p=0.984) and TLH was Rs. 47258 [(44359 - 51897), n=24] versus Rs. 53056 [(48128 - 55811), n=25] (Mann-Whitney U test, p=0.16) at Mannar and Ragama respectively. The median indirect cost (interquartile range) of TAH was Rs. 4204 (2174 12757) versus Rs. 9857 (5219 - 17251) (Mann-Whitney U test, p<0.05), NDVH was Rs.4349 (2174 - 8263) versus Rs. 10872 (5943 - 34646) (Mann-Whitney U test, p<0.01) and TLH was Rs. 6668 (2754 - 12902) versus Rs. 7538 (4929 - 21454) (MannWhitney U test, p=0.28) at Mannar and Ragama respectively. Sensitivity analysis using the best case scenario and a minimum wage of Rs. 1500 per day till time to recovery for TAH, NDVH and TLH showed a total cost of Rs. 87557, 78715 and 79150 respectively. CONCLUSION: Time-driven activity-based costing for labour and top down micro-costing of utilities helped to overcome logistical difficulties. Indirect costs at Ragama were significantly more than that at Mannar. Sensitivity analysis adjusted for the best case scenario and minimum wage suggested that NDVH and TLH may in fact be cheaper than TAH. The costing method used in this study is a simple and reproducible way of calculating costs of a surgical procedure which will serve as a guide for clinicians and policy makers in similar settings. en_US
dc.language.iso en en_US
dc.publisher Sri Lanka College of Obstetricians & Gynaecologists en_US
dc.subject Hysterectomy en_US
dc.title Challenges of costing a surgical procedure: a case study on hysterectomy en_US
dc.type Article en_US


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