Cost-effectiveness of groin hernia surgery in the Western Region of Ghana

Arch Surg. 2010 Oct;145(10):954-61. doi: 10.1001/archsurg.2010.208.


Objective: To calculate the cost-effectiveness of tension-free 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 life-years (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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Female
  • Ghana / epidemiology
  • Hernia, Inguinal / economics
  • Hernia, Inguinal / epidemiology
  • Hernia, Inguinal / surgery*
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Prospective Studies
  • Reconstructive Surgical Procedures / economics*
  • Reconstructive Surgical Procedures / methods
  • Surgical Mesh / economics*
  • Young Adult