An Economic Analysis of Safe Surgery in Low and Middle-Income Countries


With 312.9 million operations estimated worldwide in 2012 alone, surgical care is an important consideration for health systems. However, Lower and Middle Income Countries (LMICs) spend comparatively little on healthcare per capita relative to high income countries and face challenges around resource constraints.

In LMICs, shortfalls in surgical labour and surgical infrastructure limit the number of operations that can be performed, threatens the effectiveness of surgery, and can lead to adverse patient outcomes.

There is not enough surgery to address demand in many LMIC settings. Patients that do undergo surgery in LMIC settings face higher levels of postoperative complications compared to high income settings.

Surgical site infection (SSI) is the most common hospital acquired infection in LMICs and is associated with higher morbidity, mortality and financial burden. Postoperative complications can be thought of as a marker for safe surgery. However, focusing on patients receiving surgery excludes patients who have an unmet surgical need due to capacity issues.

Looking at the implications of expanding surgical provision to help address unmet surgical need is an important area for resource allocation.

Investing in improvements of patient outcomes at current and future levels of surgical provision requires a careful examination of the costs and benefits associated with reducing postoperative complications.

Main research questions:

  • 1. Is there an economic rationale for investing in safe surgery to reduce postoperative complications?

  • 2. Is there an economic rationale to increase surgical levels safely?

Structure of the study:

  • 1. Systematic review: what are the best estimates on the costs and quality of life decrement associated with SSI?

  • 2. Build a preliminary model to assess cost-effectiveness of reducing SSI.

  • 3. Generate estimates on the costs and quality of life decrement associated with SSI

    • Cost substudy alongside trial (FALCON KIWI) in four different countries (Mexico, Ghana, India, and Nigeria)

    • Remote Health State Valuation of SSI using direct valuation approaches (Standard Gamble, Time Trade-Off)

  • 4. Update the economic model based on evaluation of FALCON trial to assess cost-effectiveness of reducing SSI.

  • 5. Assess the cost-effectiveness of increasing surgery levels using task-shifting with specific reference to postoperative complications (including SSI) – Workforce Model with estimates from TIGER trial (Ghana)