Service Delivery Cost of Image-Guided Percutaneous Nephrostomy among Cervical Cancer Patients at Muhimbili National Hospital

Abstract

Introduction: Cervical cancer is among the leading cause of morbidity and mortality among women globally. Most cervical cancer patients present in health facilities with an advanced stage of the disease, with obstructive uropathy as the main complications. Management of obstructive uropathy can be done by image-guided percutaneous nephrostomy, which is only available at Muhimbili National Hospital, with no evidence of its cost and cost-effectiveness. Objective: To estimate service delivery cost of image-guided percutaneous nephrostomy among cervical cancer patients with obstructive uropathy at Muhimbili National Hospital Methods: This is a cross-sectional study, which was conducted at Muhimbili National Hospital between February and June 2021. The study was conducted from the provider perspective using a micro-costing approach, which entails identification, quantification and valuation of all resource items consumed. Costs items were classified into two categories i.e., capital (buildings, equipment and furniture) and recurrent (personnel, materials and supplies and utilities). A detailed financial analysis was performed in Excel spreadsheet (Microsoft Excel®, Microsoft Corporation). Cost data were collected in Tanzania shillings and converted to USD using the prevailing exchange rate. Capital costs were annuitized with 3% discount rate. Results: The estimated cost of performing percutaneous nephrotomy procedure at Muhimbili National Hospital was 358.56 USD per patient. One-way sensitivity analysis indicated that the unit cost was very sensitive to variation in personnel cost. The estimated cost per patient is higher than the reference price of 237.35 USD from the National Health Insurance Fund (NHIF), 259.40 USD charged to the private patients and 172.94 USD charged to the general public patients. Conclusion The cost of performing percutaneous nephrostomy among cervical patients with obstructive uropathy at Muhimbili National Hospital is estimated at358.6 USD/ patients. The estimated cost is higher than the NHIF reimbursement cost and the fee charged to private and public patients. This study underscores the importance of conducting costing studies to inform pricing decisions.