OBJECTIVES

In Africa 33,000 cases of obstetric fistula occur each year. These women experience long-term incontinence of urine and/or faeces and are often ostracized. Worldwide, Uganda ranks third among countries with highest burden of obstetric fistula. A cost-effectiveness analysis of fistula surgery at main fistula repair centers in Uganda could provide data that might convince policy-makers to prioritize this type of surgery and therefore reduce the burden of fistula.

METHODS

A decision analytic model was built to estimate cost-effectiveness of vesico-vaginal and recto-vaginal fistula surgery in a cohort of patients in Uganda. Long-term disability outcomes were assessed based on a lifetime Markov state-transition cohort and effectiveness of surgery. Disability weight associated with vesico-vaginal fistula, and mortality rate among general population in Uganda were based on published sources. Costs and disability weights were discounted at 3% annually.

RESULTS

Our model found obstetric fistula surgical repair to be the optimal strategy for management of this condition. The incremental cost of providing fistula repair in Ugandan setting is $53.87 per DALY averted. This is less than half of Uganda’s Gross Domestic Product (GDP) per capita of $620, which is the recommended threshold for evaluating cost effectiveness of interventions. In probabilistic sensitivity analyses, 100% of iterations fell below this threshold.

CONCLUSIONS

Surgery for obstetric fistula is highly cost effective in Uganda. Governments and Non Governmental Organisations need to increase access to fistula surgical care by prioritizing training and strengthening infrastructure in Uganda and similarly high burdened low-income countries, an important step towards achieving Universal Health Coverage.