Inputs for cost-effectiveness analysis.

Sierra Leone faces a substantial backlog of patients with inguinal hernia in need of repair due to a shortage of surgical providers. The current mitigation strategy includes task-sharing with associate clinicians and non-specialist medical doctors, and the economic impact of this approach needs assessment for potential scale-up. This study aimed to assess the cost-effectiveness of open mesh repair of inguinal hernias by associate clinicians and non-specialist medical doctors in adult males (>18 years) compared to no treatment, as well as between the two provider types and to estimate the budget impact of clearing the backlog in Sierra Leone. A Markov model was constructed to calculate the cost per disability-adjusted life year (DALY) averted over 10 years for operations by different providers. Subsequently, the costs of reducing the backlog through accelerated repair rates via task-sharing were assessed under two scenarios, with or without a budget limit. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the uncertainty of input values. Associate clinicians and non-specialist medical doctors achieved USD 250 and USD 411 per DALY averted, respectively, which is below the GDP per capita of USD 1,427. Associate clinicians delivered comparable health outcomes at lower costs than non-specialist medical doctors. A budget of USD 108 million was projected to clear the entire backlog over 10 years. Hernia repair by both associate clinicians and non-specialist medical doctors in Sierra Leone is highly cost-effective. Associate clinicians, with quality training and supportive supervision, are more cost-effective than non-specialist medical doctors. Task-sharing, especially with associate clinicians, is promising for optimizing access to surgical services.塞拉利昂因外科医护人员短缺，腹股沟疝待修补患者存在大量积压。当前的缓解策略包括与助理医师（associate clinicians）及非专科医师开展任务分担，但该策略的经济影响有待评估以探索其规模化推广潜力。本研究旨在评估由助理医师与非专科医师为成年男性（≥18岁）实施腹股沟疝开放式补片修补术的成本效果，对比未治疗对照组以及两种医护提供者之间的差异，并估算塞拉利昂清空患者积压所需的预算影响。本研究构建马尔可夫模型（Markov model），用于计算不同医护提供者实施手术后10年内每挽回1个伤残调整生命年（disability-adjusted life year, DALY）所需的成本。随后，本研究在有预算限制与无预算限制两种场景下，评估通过任务分担提升手术修补速率以减少患者积压所需的成本，并开展确定性敏感性分析与概率敏感性分析以评估输入参数的不确定性。结果显示，助理医师与非专科医师每挽回1个DALY的成本分别为250美元与411美元，均低于该国1427美元的人均国内生产总值（GDP）；相较于非专科医师，助理医师以更低成本实现了相当的健康结局。预计在10年内清空全部患者积压所需的预算为1.08亿美元。在塞拉利昂，由助理医师与非专科医师实施的疝修补术均具有极高的成本效果比；经过优质培训与支持性督导的助理医师，其成本效果比优于非专科医师。任务分担策略，尤其是与助理医师开展的任务分担，有望优化外科医疗服务的可及性。