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Cost-Effectiveness of a Locally Organized Surgical Outreach Mission: Making a Case for Strengthening Local Non-Governmental Organizations

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Abstract

Introduction

Many low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to assess the cost-effectiveness of surgical outreach missions provided by a wholly local organization in Ghana to highlight the role local groups might play in reducing the unmet surgical need of their communities.

Methods

We calculated the disability-adjusted life years (DALY) averted by surgical outreach mission activities of ApriDec Medical Outreach Group (AMOG), a Ghanaian non-governmental organization. The total cost of their activities was also calculated. Conclusions about cost-effectiveness were made according to World Health Organization (WHO)-suggested parameters.

Results

We analyzed 2008 patients who had been operated upon by AMOG since December 2011. Operations performed included hernia repairs (824 patients, 41%) and excision biopsy of soft tissue masses (364 patients, 18%). More specialized operations included thyroidectomy (103 patients, 5.1%), urological procedures (including prostatectomy) (71 patients, 3.5%), and plastic surgery (26 patients, 1.3%). Total cost of the outreach trips was $283,762, and 2079 DALY were averted; cost per DALY averted was 136.49 USD. The mission trips were “very cost-effective” per WHO parameters. There was a trend toward a lower cost per DALY averted with subsequent outreach trips organized by AMOG.

Conclusion

Our findings suggest that providing surgical services through wholly local surgical mission trips to underserved LMIC communities might represent a cost-effective and viable option for countries seeking to reduce the growing unmet surgical needs of their populations.

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Acknowledgements

The authors thank all regional and local health authorities of the northern, upper east, and upper west regions, local community leaders, and all volunteers of AMOG.

Funding

This study was funded in part by ApriDec Medical Outreach Group, a Ghanaian-based non-governmental organization, and grant R25-TW009345 from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Adam Gyedu

  2. Department of Surgery, University of Washington, Seattle, WA, USA

    Cameron Gaskill

  3. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Godfred Boakye

  4. Department of Surgery, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana

    Francis Abantanga

Authors
  1. Adam Gyedu
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  2. Cameron Gaskill
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  3. Godfred Boakye
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  4. Francis Abantanga
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Contributions

Gyedu and Abantanga were involved in the study concept and design; Gyedu, Gaskill, Boakye, Abantanga, and AMOG were involved in the acquisition, analysis, and interpretation of data; Gyedu, Gaskill, and Boakye were involved in drafting of the manuscript; All authors were involved in the critical revision of the manuscript for important intellectual content; All authors provided administrative, technical, or material support.

Corresponding author

Correspondence to Adam Gyedu.

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Conflict of interest

The authors declare no competing interest of any form related directly or indirectly to the subject of this article.

Appendix 1: examples of DALY averted estimation

Appendix 1: examples of DALY averted estimation

A 12-year-old male with acute appendicitis (GBD 2015 disability weight = 0.324) has more than 95% chance of being fatal or disabling without surgery (i.e., a disease severity score = 1), more than 95% chance of being cured after surgery (i.e., effectiveness of treatment score = 1), and a life expectancy of 56.1 years in 2015. A successful appendectomy will avert 56.1 × 1 × 1 × 0.324 = 18.18 DALY.

A 26-year-old female with placental abruption (GBD 2015 disability weight = 0.324) has more than 95% chance of being fatal or disabling without surgery (i.e., a disease severity score = 1), more than 95% chance of being cured after surgery (i.e., effectiveness of treatment score = 1), and a life expectancy of 44.9 years in 2013. A successful cesarean section will avert 44.9 × 1 × 1 × 0.324 = 14.55 DALY.

A 34-year-old male with femoral fracture (GBD 2015 disability weight = 0.111) has a limited ability to perform most recreational, occupational, educational and procreation activities (i.e., a disability severity score = 0.6), more than 95% chance of being cured after surgery (i.e., effectiveness of treatment score = 1), and a life expectancy of 38.8 years in 2012. A successful open reduction and internal fixation will avert 38.8 × 0.6 × 1 × 0.111 = 2.58 DALY.

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Gyedu, A., Gaskill, C., Boakye, G. et al. Cost-Effectiveness of a Locally Organized Surgical Outreach Mission: Making a Case for Strengthening Local Non-Governmental Organizations. World J Surg 41, 3074–3082 (2017). https://doi.org/10.1007/s00268-017-4131-3

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  • DOI: https://doi.org/10.1007/s00268-017-4131-3

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