The cost-effectiveness of orthopaedic clinical officers in Malawi

Trop Doct. 2014 Jul;44(3):128-34. doi: 10.1177/0049475514535575. Epub 2014 May 12.


Background: In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program.

Methods: Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted.

Results: The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58-207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the 'economically active' demographic of ages 15-74 years.

Conclusion: Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.

Keywords: Cost-effectiveness; Orthopaedic clinical officers; Task shifting.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allied Health Personnel / economics
  • Allied Health Personnel / education
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Delivery of Health Care / economics
  • Education, Medical / economics
  • Female
  • Hospital Costs / statistics & numerical data
  • Humans
  • Infant
  • Malawi
  • Male
  • Middle Aged
  • Orthopedic Procedures / economics*
  • Orthopedic Procedures / statistics & numerical data
  • Orthopedics / economics*
  • Orthopedics / education
  • Orthopedics / statistics & numerical data
  • Quality-Adjusted Life Years
  • Young Adult