The Economic Burden of Musculoskeletal Injuries in Northern TanzaniaSonya Davey MPhil 1, Evgeny Bulat MA 1, Amani Lupenza MD 2, Honest Massawe MD 2, Anthony Pallangyo MD 2, Ajay Premkumar MD MPH 3, Neil Sheth MD 4

1 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 2 Department of Orthopaedics and Traumatology, Killimanjaro Christian Medical Center, Moshi, Tanzania3 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA; 4 Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Methods• Cross-sectional written survey conducted over five

outpatient orthopaedics clinic days at Kilimanjaro Christian Medical Center, Moshi, Tanzania

• 200 patients (60%) agreed to participate in the survey (91-95% estimated completion rate)

• Survey was in Swahili• Approved by KCMC’s research ethics committee

IntroductionMorbidity and Mortality:• With 32.9 deaths per 100,000, Tanzania had the 7th

highest mortality rate from road traffic accidents in 2013 (World Health Statistics 2013)

• Data from LMICs demonstrate the incidence of permanent disability due to traumatic injury estimated at 50-times higher than mortality rate (O’Hara et al. 2015)

Costs of Orthopaedic Trauma:Direct costs: Hospital Expenses • Analysis of the Tanzania National Panel survey found

that out-of-pocket costs are a serious obstacle to accessing healthcare among lower income laborers (Brinda 2014)

Indirect costs: Loss of Work and Productivity • The costs from lost work and productivity due to

disability to due injury are estimated to be 2 to 3.6-times greater than hospital costs in LMICs (McIntyre et al 2005)

Study Aim: The aim of this study is to explore the socioeconomic burden of orthopaedic injuries in Tanzania by examining both the direct hospital costs and the economic costs of prolonged disability

Results

In Context• There is limited data on orthopedic healthcare costs

and disability in Sub-Saharan Africa• Direct cost: Data from 15 African countries shows

that 50% of households financed out-of-pocket expenditure from hospitalizations by borrowing or selling assets (Leive and Xu 2008)

• Indirect cost: Four studies that quantified disability status post-injury in various countries in Sub-Saharan Africa found that 67% of patients were disabled and 83-88% of patients had a decreased in income post-injury (Julliard et al 2010, O’ Hara et al 2015, Mock et al 2003, El Tayeb et al 2015)

83% of the patients surveyed did not complete high school and 88.8% reported a monthly income of less than $250.

Direct healthcare out-of-pocket costs exceeded monthly income for 75% of patients. 74% of patients cited healthcare costs as a catastrophic burden to them and their family.

Although patients with healthcare insurance had 20% lower out-of-pocket costs, the correlation between decreased out-of-pocket total costs and health insurance was not significant (p=.26) The Community Health Fund of Tanzania does not currently cover large surgeries.

52.9% of patients were unable to perform daily activities of living post-injury. 75.3% of patients lost greater than 30 days of functionality due to their injury; median(IQR) lost days of functionality lost was 90(30). 86.7% of disabled patients reported a wage decrease. There was a significant association between disability and post-injury unemployment (p<.0001).