Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis.

BACKGROUND: Short-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective. METHODS: Using a provider perspective, the costs of implementing the surgical trips were collected via Esperança's previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year. RESULTS: Esperança's surgical missions' program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate. CONCLUSIONS: The cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.

Why do patients receive care from a short-term medical mission? Survey study from rural Guatemala.

BACKGROUND: Hospital de la Familia was established to serve the indigent population in the western highlands of Guatemala and has a full-time staff of Guatemalan primary care providers supplemented by short-term missions of surgical specialists. The reasons for patients seeking surgical care in this setting, as opposed to more consistent care from local institutions, are unclear. We sought to better understand motivations of patients seeking mission-based surgical care. METHODS: Patients presenting to the obstetric and gynecologic, plastic, ophthalmologic, general, and pediatric surgical clinics at the Hospital de la Familia from July 27 to August 6, 2015 were surveyed. The surveys assessed patient demographics, surgical diagnosis, location of home, mode of travel, and reasons for seeking care at this facility. RESULTS: Of 252 patients surveyed, 144 (59.3%) were female. Most patients reported no other medical condition (67.9%, n = 169) and no consistent income (83.9%, n = 209). Almost half (44.9%, n = 109) traveled >50 km to receive care. The most common reasons for choosing care at this facility were reputation of high quality (51.8%, n = 130) and affordability (42.6%, n = 102); the least common reason was a lack of other options (6.4%, n = 16). CONCLUSIONS: Despite long travel distances and the availability of other options, reputation and affordability were primarily cited as the most common reasons for choosing to receive care at this short-term surgical mission site. Our results highlight that although other surgical options may be closer and more readily available, reputation and cost play a large role in choice of patients seeking care.

Short-term surgical mission to the Dominican Republic: a cost-benefit analysis.

OBJECTIVE: This study determines the cost-effectiveness of a recurring short-term surgical mission trip to the Dominican Republic. BACKGROUND: The global burden of surgical disease is significant. Recent investigations have shown surgical treatment to be cost-effective at established hospitals within low- or middle-income countries (LMIC), drawing attention to surgical diseases world-wide. Another method of providing general surgical care in LMIC is short-term mission trips, but no studies have examined their cost-effectiveness. METHODS: Consecutive week-long trips by the Midwest Medical Missions Michigan Chapter to the Dominican Republic were studied in 2010 and 2012. All costs were recorded, and operative logs were maintained. Costs of identical procedures carried out at the authors' host institution were estimated. Direct comparisons were made between the cost of surgeries performed in the USA and the estimated amount of money spent on the mission trips attributable to each procedure. Disability-adjusted life years (DALYs) averted were calculated for both trips. RESULTS: The cost for all cases in 2010 would have been $255,187 if performed at the United States hospital and $398,177 in 2012. The amount actually spent on the trips was $61,924 in 2010 and $82,368 in 2012 - a relative cost-reduction of 79%. 473 DALYs were averted. An average of 6.9 DALYs were averted per patient, and the cost per DALY averted was $304.88. CONCLUSIONS: The procedures on a surgical mission trip to the Dominican Republic were less expensive than similar care provided in the United States. The cost per DALY averted is low, demonstrating the cost-effectiveness of the trips.

Cost effectiveness of a short-term pediatric neurosurgical brigade to Guatemala.

OBJECTIVE: With subspecialty surgical care often unavailable to poor patients in developing countries, short-term brigades have filled a portion of the gap. We prospectively assessed the cost effectiveness of a pediatric neurosurgical brigade to Guatemala City, Guatemala. METHODS: Data were collected on a weeklong annual pediatric neurosurgical brigade to Guatemala. Disability adjusted life-years (DALYs) averted were the metric of surgical effectiveness. Cost data included brigade expenses, as well as all costs incurred by the local health care system and patient families. RESULTS: During the mission, 17 pediatric neurosurgical interventions were performed. Conditions these patients suffered would result in 382 total DALYs. Using conservative values of surgical effectiveness, procedures performed averted 138.1 DALYs. Although all operative and postoperative costs were covered by the visiting surgical team, patients spent an average of $226 in U.S. dollars for preoperative workup, travel, food/lodging, and lost wages (range, $36-$538). The local health care system absorbed a total cost of $12,910. Complete mission costs were $53,152, for a cost effectiveness of $385 per DALY averted. CONCLUSIONS: To our knowledge, this is the first study evaluating cost effectiveness of a short-term neurosurgical brigade. Although surgical intervention is acknowledged as playing a crucial role in global health, subspecialty surgical care is still broadly perceived as a luxury. Although providing care through local surgeons is undeniably more efficient than bringing in foreign medical teams, such care is not universally available. This study argues that volunteer neurosurgical teams can provide high complexity care with a competitive cost-effective profile.

A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic.

INTRODUCTION: Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at non-profit organization (NPO) costs would lead to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic. METHODS: Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost-savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α = 0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS: The mean cost-savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (n = 13); $332.46 ± $184.09 for bilateral inguinal hernia repair (n = 3); $127.26 ± $13.18 for hydrocelectomy (n = 9); $232.92 ± $56.49 for femoral hernia repair (n = 3); $120.90 ± $30.51 for umbilical hernia repair (n = 8); $36.59 ± $17.76 for minor procedures (n = 26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (n = 7). CONCLUSION: Supply acquisition at NPO costs leads to significant cost-savings compared with supply acquisition at US academic institution costs from the provider perspective for inguinal hernia repair, hydrocelectomy, umbilical hernia repair, minor procedures, and pediatric inguinal hernia repair during a surgical mission in the Dominican Republic. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.

Organizing a dermatology service mission.

BACKGROUND: There are few published guidelines that describe the forethought and logistical considerations needed to create a dermatology-specific medical mission. OBJECTIVE: To report the experience of planning and executing a successful medical mission to an underserved community in Puerto Rico. METHODS: We identified an area of need and projected the volume of patients and diseases to be treated. After recruiting medical staff, pharmaceutical and surgical supplies were collected. Important concerns included establishing the scope of medical and educational services to be rendered, advertising the clinic, arranging for biopsy processing, ensuring follow-up, and selecting a method for medical documentation. We tracked the number of patients seen, diagnoses made, and materials used to prepare for future missions. RESULTS: We recruited 12 physicians and 25 ancillary (i.e. nonlicensed physician) staff members, including: six dermatologists, four internists, one pathologist, one psychiatrist, 23 medical students, and two medical assistants. We secured 12 examination rooms in an existing medical facility. Two pharmaceutical companies and two pathology companies provided the medications and surgical supplies with the remainder coming from the volunteer physicians' offices. Three thousand dollars were raised and used toward purchasing additional supplies. Advertising via public announcements resulted in the attendance of 166 patients during the 1-day clinic. A total of 41 procedures were performed, including 14 biopsies, five excisions, three incisions and drainage, and 19 electrodessications and curettage. CONCLUSION: Proper planning is critical in creating a successful dermatology mission. Documenting the care given and supplies used helps to identify needs and optimize limited resources for future missions. The goal of a self-sustaining public health service starts with patient education and coordination with the local healthcare providers.

Volunteer orthopedic surgical trips in Nicaragua: a cost-effectiveness evaluation.

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.

Fifty years of Cuba's medical diplomacy: from idealism to pragmatism.

Medical diplomacy, the collaboration between countries to simultaneously produce health benefits and improve relations, has been a cornerstone of Cuban foreign policy since the outset of the revolution fifty years ago. It has helped Cuba garner symbolic capital (goodwill, influence, and prestige) well beyond what would have been possible for a small, developing country, and it has contributed to making Cuba a player on the world stage. In recent years, medical diplomacy has been instrumental in providing considerable material capital (aid, credit, and trade), as the oil-for-doctors deals with Venezuela demonstrates. This has helped keep the revolution afloat in trying economic times. What began as the implementation of the one of the core values of the revolution, namely health as a basic human right for all peoples, has continued as both an idealistic and a pragmatic pursuit. This article examines the factors that enabled Cuba to conduct medical diplomacy over the past fifty years, the rationale behind the conduct of this type of soft power politics, the results of that effort, and the mix of idealism and pragmatism that has characterized the experience. Moreover, it presents a typology of medical diplomacy that Cuba has used over the past fifty years.

The maturing of MEDRETEs.

The Medical Readiness Training Exercise (MEDRETE) is generally regarded as an effective tool for enhancement of U.S. foreign policy in developing nations. However, if MEDRETEs are evaluated with parameters other than emotion, there is found to be little durable effect and virtually no improvement in the health status of the host nation. The classic MEDRETE is ineffective, costly, and provides only an evanescent benefit to the served population. It should be replaced by PMRETEs (Preventive Medicine Readiness Training Exercises) targeting preventive medicine concerns which would provide low-cost, durable contributions to the health status of growing nations.