J. Rickard1,2, C. Ngarambe1,3, L. Ndayizeye1,3, B. Smart5, R. Riviello1,2, J. Majyambere4 4Kibungo Referral Hospital,Kibungo, , Rwanda 5Rush University Medical Center,Chicago, IL, USA 1University Teaching Hospital Of Kigali,Department Of Surgery,Kigali, , Rwanda 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 3University Of Rwanda,College Of Medicine And Health Sciences,Kigali, , Rwanda
Introduction:
Many different surgical procedures have been shown to be cost-effective interventions. While peritonitis often requires surgical intervention, little is known regarding the associated costs, particularly in low- and middle-income countries.
Methods:
As part of a larger study examining the epidemiology and outcomes of patients with peritonitis at a referral hospital in Rwanda, hospital costs associated with peritonitis were examined. Data were collected on demographics, clinical features, and outcomes. Continuous variables were reported as means and standard deviations (SD). Costs were reported as US dollars (USD).
Results:
Over a six-month period, 281 patients underwent operation for peritonitis. Common diagnoses included: obstruction (39%), appendicitis (17%), and trauma (14%). 254 (93%) patients had government-sponsored health insurance, covering at least 90% of in-hospital costs.
Cost analyses were available for 245 patients. The mean total hospital cost was 379 USD (SD 325), which is 58% of the Rwanda gross national income per capita. Mean patient cost was 42 USD (SD 79). Medications comprised the largest proportion (37%) of total hospital costs (mean 142 USD, SD 171).
Total hospital cost varied with length of hospital stay and diagnosis. Hospital stay was longer in patients diagnosed with typhoid perforation (mean 18.1 days, SD 15.6) and cholecystitis (mean 14.3 days, SD 4.9). Higher costs were seen in patients diagnosed with cholecystitis (mean 760 USD, SD 530) and typhoid perforation (mean 726 USD, SD 442).
Conclusion:
Surgical costs for peritonitis at a Rwandan referral hospital were reasonable, though total hospital costs equate to a significant portion of gross national income per capita. Most patients were eligible for government-sponsored insurance, which minimized costs for patients and families. Decreasing the length of hospital stay and minimizing costs is critical in a low-resource setting to decrease the financial burden of disease.