title: Short-term surgical mission to the Dominican Republic: a cost-benefit analysis.
abstract: 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.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA. Electronic address: eglejona@gmail.com.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Egle
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Alasdair
authors.initials: A
authors.lastname: McKendrick
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
authors.affiliation: Department of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Freddy
authors.initials: F
authors.lastname: Sosa
mesh_terms: D003362:Cost-Benefit Analysis; D004293:Dominican Republic; D005260:Female; D006801:Humans; D008297:Male; D008493:Medical Missions / Q000191:economics*; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Cost-benefit analysis; Global surgery; Low- and middle-income countries; Mission trip