Presentation (CTI)

OBJECTIVES: This study aims to explore the extent to which modified equity-informative cost-effectiveness analysis and patient-level simulation modelling can provide evidence on the impact of surgical task-shifting on fair access to surgery, in addition to evidence on cost-effectiveness.
METHODS: A patient-level discrete-event simulation model was developed based on a previous cohort model used to evaluate the cost-effectiveness of surgical task-shifting for C-section in Sierra Leone. Additional equity-of-access variables (socio economic status, district and travel time) were assigned to each patient which determined their pathway to receipt of care. Health outcomes and costs were disaggregated according to these characteristics and distributions were analysed, guided by distributional cost-effectiveness analysis methods but adapted to provide evidence of equity of access impacts besides cost-effectiveness.
RESULTS: Results indicate that surgical task-shifting for C-section in Sierra Leone improves overall access and equity-of-access to C-section across wealth quintiles, alongside improving health outcomes and reducing costs. It is therefore beneficial in progress towards universal health coverage besides being a cost-effective means to improving provision of C-section in Sierra Leone.
CONCLUSIONS: We demonstrate that standard methods of cost-effectiveness analysis can be adapted to also provide evidence on equity-of-access to care using modified equity-informative cost-effectiveness analysis methods. This can be important where health decision makers want to identify interventions that will support progress towards universal health coverage. Using patient-level simulation modelling approaches can be useful in providing evidence on equity-of-access impacts of interventions alongside cost-effectiveness and are likely to be more efficient than undertaking similar analyses using cohort models.