title: Orthopaedic trauma care in Haiti: a cost-effectiveness analysis of an innovative surgical residency program.
abstract: OBJECTIVE
  In an effort to sustainably strengthen orthopaedic trauma care in Haiti, a 2-year Orthopaedic Trauma Care Specialist (OTCS) program for Haitian physicians has been developed. The program will provide focused training in orthopaedic trauma surgery and fracture care utilizing a train-the-trainer approach. The purpose of this analysis was to calculate the cost-effectiveness of the program relative to its potential to decrease disability in the Haitian population.
  
  
  METHODS
  Using established methodology originally outlined in the World Health Organization's Global Burden of Disease project, a cost-effectiveness analysis was performed for the OTCS program in Haiti. Costs and disability-adjusted life-years (DALYs) averted were estimated per fellow trained in the OTCS program by using a 20-year career time horizon. Probabilistic sensitivity analysis was used to simultaneously test the joint uncertainty of the cost and averted DALY estimates. A willingness-to-pay threshold of $1200 per DALY averted, equal to the gross domestic product per capita in Haiti, was selected on the basis of World Health Organization's definition of highly cost-effective health interventions.
  
  
  RESULTS
  The OTCS program results in an incremental cost of $1,542,544 ± $109,134 and 12,213 ± 2,983 DALYs averted per fellow trained. The cost-effectiveness ratio of $133.97 ± $34.71 per DALY averted is well below the threshold of $1200 per DALY averted. Furthermore, sensitivity analysis suggests that implementing the OTCS program is the economically preferred strategy with more than 95% probability at a willingness-to-pay threshold of $200 per DALY averted and across the entire range of potential variable inputs.
  
  
  CONCLUSIONS
  The current economic analysis suggests the OTCS program to be a highly cost-effective intervention. Probabilistic sensitivity analysis demonstrates that the conclusions remain stable even when considering the joint uncertainty of the cost and DALY estimates.
authors.affiliation: University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA.
authors.forename: Lucas C
authors.initials: LC
authors.lastname: Carlson
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pollak
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D006233:Persons with Disabilities; D005382:Financing, Personal; D050723:Fractures, Bone / Q000601:surgery; D006205:Haiti; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D015233:Models, Statistical; D019637:Orthopedic Procedures; D019057:Quality-Adjusted Life Years; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult