Economic evaluation of expanding inguinal hernia repair among adult males in Sierra Leone

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.