Cost-Minimization Analysis of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Kenya

Purpose: Timely access to safe and affordable surgery is central to Kenya’s agenda for sustainable development. The primary aim of this study is to perform a cost-minimization analysis to determine if WALANT, when compared with alternative anesthetic techniques, is the least costly in Kenya for simple upper and lower limb surgeries. The secondary aim of this study is to be the largest study to date to conduct an economic evaluation on the WALANT techniques for simple upper and lower limb procedures.

Methods: This is an economic evaluation done in 4 major hospitals in Kenya. The study focused on patients who underwent surgery using the WALANT technique between January 2021 and May 2022. This economic evaluation assessed economic costs from a health system perspective, focusing on direct medical care costs. The cost data for both intervention and comparator included the cost of the resources and the cost of delivering it. Costs that would remain the same between the intervention and comparator were excluded. Descriptive statistics were used to report the demographic characteristics of the participants.

Results: 640 patients were screened for eligibility for this study. Of these, 590 patients were included in the intervention arm of this economic evaluation. 590 matched participants who were given non-WALANT anesthesia were used for comparison. The cost of using the WALANT technique was found to be approximately one-third of the cost of similar procedures done under the non-WALANT forms of anesthesia. All participants were African by ethnicity and Kenyan by nationality.

Conclusion: Our study also demonstrates that performing surgeries of the extremities and other selected surgeries using the WALANT technique results in a reduction in overall costs compared to alternative forms of anesthesia. The purported benefits of WALANT makes this anesthetic method an attractive option for surgeons, patients, and health-care stakeholders in Kenya.