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

Figures

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  Fig 1. Markov model. The model includes four exclusive health states related to inguinal hernia: new hernia (primary hernia that has not previously been treated), recurrent hernia (hernia that reappears after initial surgical repair), repaired hernia (hernia that has been surgically treated and is in a post-treatment state), and death. If they receive treatment, they transition to the ’repaired’ state. From there, they may either remain in that state or move to the ’recurrent’ state or back to the ’new hernia’ state in subsequent cycles, based on the risk of recurrent and contralateral hernias, as indicated by arrows in the diagram. All health states can ultimately lead to the absorbing state of death, influenced by the risks of WHO’s age-specific mortality and premature death without surgery.

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  Fig 2. Deterministic sensitivity analysis of Incremental Cost-effectiveness Ratios (ICERs). AC Associate Clinician; DW Disability Weight; IPQ Inguinal Pain Questionnaire; MD Medical Doctor. The tornado diagram displays the percent decrease or increase in ICER values for hernia repair against various comparator groups, resulting from variations in each model input. The upper and lower estimates represent the range of variability in the data, indicating the highest and lowest values for each parameter analysed. (A) hernia repair by MDs vs. no repair, (B) hernia repair by ACs vs. no repair, (C) hernia repair by ACs vs. hernia repair by MDs.

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  Fig 3. Stochastic sensitivity analysis of Incremental Cost-effectiveness Ratios (ICERs). AC Associate Clinician; DALY Disability-adjusted Life Year; MD Medical Doctor. The scatter plot illustrates deterministic and stochastic values of incremental cost (in USD millions) and incremental DALYs averted (in thousands) from hernia repair against various comparator groups within a cost-effectiveness plan, accounting for variations in model inputs. (A) hernia repair by MDs vs. no repair, (B) hernia repair by ACs vs. no repair, (C) hernia repair by ACs vs. hernia repair by MDs.

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  Fig 4. Cost-effectiveness acceptability curves. AC Associate Clinician; DALY Disability-adjusted Life Year; MD Medical Doctor. The line graph depicts the probability of cost-effectiveness for inguinal hernia repair by ACs and MDs vs. no repair at various threshold values for a DALY averted ($).

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  Fig 5. Inguinal hernia repair expansion for adult males in Sierra Leone (2024–2033). The graph illustrates the budget impact on untreated cases (in thousands) over the next decade.