title: Cost effectiveness of a short-term pediatric neurosurgical brigade to Guatemala.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. Electronic address: matthewdavis@uabmc.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Khoi D
authors.initials: KD
authors.lastname: Than
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Garton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D006166:Guatemala; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy; D008297:Male; D008493:Medical Missions / Q000191:economics*; D008588:Meningocele / Q000191:economics / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D010372:Pediatrics / Q000191:economics*; D019057:Quality-Adjusted Life Years; D066231:Surgeons; D017287:Ventriculoperitoneal Shunt / Q000191:economics; D014838:Volunteers; D055815:Young Adult
keywords: Cost effectiveness; Medical missions; Neurosurgery; Pediatrics