An economic evaluation of day surgery for non-acute hernia repair in Sri Lanka in 2022

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Kim, Hansoo
Gamage, Anuji
De Silva, Amala
Yogeswaran, Suganya
Senanayake, Lakshmen
Dias, Ranjan
Dong, Di
Attygalle, Deepika Eranjanie
Higashi, Hideki
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Early discharge of publicly funded non-acute hernia patients after surgery may save health care costs by reducing inpatient bed-days. An economic evaluation was conducted to examine the cost implications of implementing day care surgeries for non-acute hernia cases for publicly funded patients to improve the efficiency of the public health system in Sri Lanka. A linked decision tree model was developed and populated using secondary data to model the pathway probabilities and costs. Cost data were obtained from the Medical Supplies Division, relevant hospitals, and laboratories. Hospital hotel costs per bed-day were calculated based on WHO-CHOICE1 model estimations with inflation adjusted to the 2022 value. The model assumed that 5 percent of patients would encounter surgical complications. In the current standard of care situation for a cohort of 40,401 patients undergoing non-acute hernia repair, the decision tree model estimated that an average of 4.05 hospital bed-days were utilized for non-acute hernia repair including those experiencing surgical complications. With day surgery, patients without surgical complications spend less than 24 hours before being discharged, and the average length of stay can be reduced to 1.15 bed-days including those with surgical complications. In the standard of care scenario, the total cost for non-acute hernia repair at a public hospital was estimated LKR 164,968 per patient, while the same procedure performed as a day surgery would reduce the cost to LKR 145,622 per patient. The savings from implementing day surgeries for non-acute hernia cases will amount to approximately LKR 781.6 million (approximately USD 2.4 million). Shifting uncomplicated non-acute hernia patients from an inpatient scenario to a day surgery could result in considerable cost saving to the government. More studies on the benefit of expanding day surgery services to other conditions are warranted, which would further inform the government on options to maximize efficiency in the publicly funded health care system of Sri Lanka.

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Kim, H; Gamage, A; De Silva, A; Yogeswaran, S; Senanayake, L; Dias, R; Dong, D; Attygalle, DE; Higashi, H, An economic evaluation of day surgery for non-acute hernia repair in Sri Lanka in 2022, 2023