Costing analysis of outpatient services for major external structural birth defects: An ingredient approach in selected hospitals in Kiambu County, Kenya

Background: Major external structural birth defects are known to exert an enormous economic burden on individuals and health services; however, they have been vastly unappreciated and underprioritized as a public health problem in settings where costing analyses are limited. Objective: The objective of this study was to conduct a costing analysis of outpatient services for major external structural birth defects in selected hospitals in Kiambu County, Kenya. Methods: A hospital-based cross-sectional study design was adopted in four hospitals where an ingredient approach was used to retrospectively gather data on cost drivers for interventions consisting of  castings, bracings, and tendonectomies for the under-fives from health care providers’ perspectives for a one-year time horizon (January 1 st , 2018, to December 31 st , 2018). The hospitals were selected for providing outpatient corrective and rehabilitative services to the under-fives. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff-time for the hospitals’ executives comprising the medical superintendents, chief nursing officers, orthopedic surgeons, and health administrative officers were gathered through face-to-face enquires from the occupational therapists being the closest proxies for the officers. Following a predefined inclusion criterion, 349 cases were determined, and associated cost drivers identified, measured, and valued (quantified) using prevailing market prices. The costs were categorized as recurrent, and unit economic costs calculated as average costs, expressed in U.S Dollars, and inflated to the U.S Dollar Consumer Price Index from January 2018 to December 2018. Results: The unit economic cost of all the cases was estimated at $1,139.73; and $1,143.51 for neural tube defects, $1,143.05 for congenital talipes equinovarus, and $1,109.81 for congenital pes planus. Conclusions : The highest economic burden of major external structural birth defects in the county was associated with neural tube defects, followed by congenital pes planus despite having the fewest caseloads.