World Journal of Surgery

, Volume 36, Issue 12, pp 2802–2808

Volunteer Orthopedic Surgical Trips in Nicaragua: A Cost-effectiveness Evaluation

  • Andrew T. Chen
  • Andrew Pedtke
  • Jeffrey K. Kobs
  • George S. EdwardsJr.
  • R. Richard  Coughlin
  • Richard A. Gosselin
Article

Abstract

Background

Injuries account for a substantial portion of the world’s burden of disease and require effective surgical care. Volunteer surgical teams that form partnerships with hospitals help build local surgical capacity while providing immediate care. The purpose of the present study was to evaluate the cost-effectiveness of short orthopedic surgical volunteer trips as a method of reducing the global burden of surgical disease through both surgical and educational interventions.

Methods

Data were collected from a scheduled volunteer trip to Leon, Nicaragua, in January 2011 as part of the Cooperación Ortopédica Americano Nicaraguense (COAN), a 501c3 nonprofit organization established in 2002. Costs are from the COAN provider prospective with an additional analysis to include the Nicaraguan provider variable costs. The total burden of musculoskeletal disease averted from the patients receiving surgical intervention was derived using the disability-adjusted-life-years (DALYs) framework and disability weights from the disease control priority project. The cost-effectiveness ratio was calculated by dividing the total costs by the total DALYs averted.

Results

A total of 44.78 DALYs were averted in this study, amounting to an average of 1.49 DALYs averted per patient. The average cost per patient from the COAN provider perspective was $525.64, and from both the COAN and Nicaraguan provider perspective it was $710.97. In the base case, cost-effectiveness was $352.15 per DALY averted, which is below twice the Nicaraguan per capita gross national income ($652.40).

Conclusions

Volunteer orthopedic surgical trips are cost-effective in Nicaragua. Further research should be conducted with multiple trips and with different patient populations to test the generalizability of the results.

References

  1. 1.
    The Global Burden of Disease: Annex A: Deaths and DALYs 2004 annex tables. In the global burden of disease, 2004th edition, Geneva, World Health OrganizationGoogle Scholar
  2. 2.
    Daar AS, Rizvi SA, Naqvi SA (2000) Surgery with limited resources. In: Morris PJ, Wood W (eds) Oxford textbook of surgery, 2nd editon. Oxford University Press, New York, pp 3380–3395Google Scholar
  3. 3.
    Shillcutt SD, Clarke MG, Kingsnorth AN (2010) Cost-effectiveness of groin hernia surgery in the western region of Ghana. Arch Surg 145:954–961PubMedCrossRefGoogle Scholar
  4. 4.
    Beveridge M, Howard A (2004) The burden of orthopaedic disease in developing countries. J Bone Joint Surg Am 86–A:1819–1822PubMedGoogle Scholar
  5. 5.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144PubMedCrossRefGoogle Scholar
  6. 6.
    Bickler SW (2008) Spiegel DA global surgery—defining a research agenda. Lancet 372(9633):90–92PubMedCrossRefGoogle Scholar
  7. 7.
    Gosselin RA, Heitto M (2008) Cost-effectiveness of a district trauma hospital in Battambang, Cambodia. World J Surg 32:2450–2453. doi:10.1007/s00268-008-9708-4 PubMedCrossRefGoogle Scholar
  8. 8.
    McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynecol Obstet 81:83–92CrossRefGoogle Scholar
  9. 9.
    Wolfberg AJ (2006) Volunteering overseas—lessons from surgical brigades. N Engl J Med 354:443–445PubMedCrossRefGoogle Scholar
  10. 10.
    Lopez AD, Mathers CD, Etzatti M et al (eds) (2006) Global burden of disease and risk factors. Oxford University Press, WashingtonGoogle Scholar
  11. 11.
    Murray CJL, Lopez AD (eds) (1996) The global burden of disease. Harvard University Press, CambridgeGoogle Scholar
  12. 12.
    The WHO guides on assessing the environmental burden of disease. http://www.who.int/quantifying_ehimpacts/publications/en/9241546204chap3.pdf. Accessed June 25, 2012
  13. 13.
    Gosselin RA, Gialamas G, Atkin DM (2011) Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries. World J Surg 35:951–955. doi:10.1007/s00268-010-0947-9 PubMedCrossRefGoogle Scholar
  14. 14.
    Garber AM, Phelps CE (1997) Economic foundations of cost-effectiveness analysis. J Health Econ 16:1–31PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Andrew T. Chen
    • 1
  • Andrew Pedtke
    • 1
  • Jeffrey K. Kobs
    • 2
  • George S. EdwardsJr.
    • 2
  • R. Richard  Coughlin
    • 1
  • Richard A. Gosselin
    • 1
  1. 1.Institute for Global Orthopedics and TraumatologyUniversity of California at San FranciscoSan FranciscoUSA
  2. 2.Cooperación Ortopédica Americano Nicaraguense (COAN)RaleighUSA

Personalised recommendations