title: A Systematic Review of Economic Analysis of Surgical Mission Trips Using the World Health Organization Criteria.
abstract: Although the World Health Organization (WHO) has developed tools to standardize economic evaluations of global health interventions, little is known about the cost-effectiveness of surgical mission trips and their economic values. Our objective was to systematically evaluate the current literature on surgical volunteering trips to measure their adherence to WHO CHOosing Interventions that are cost-effective (WHO-CHOICE). We hypothesized that the majority of studies use some type of cost-effectiveness analysis that do not adhere to these standards.
  
  
  
  A systematic review of Pubmed, Medline, and Embase databases was performed in accordance with PRISMA guidelines, with inclusion criteria set a priori. Of the 908 publications screened, 72 were selected for full text review; 17 met inclusion criteria.
  
  
  
  Only 17 out of 72 studies reported some type of economic analysis. We categorized the studies into service, educational, and combination (service and educational) surgical trips. Although seven of the service studies calculated the cost per disability-adjusted life year averted, the results were not based on WHO-CHOICE standards to facilitate comparisons among alternative options. Furthermore, none of the three educational trips calculated the value of the education provided, but only published cost estimates of the resources used during the trip.
  
  
  
  Although a few studies performed some type of economic analysis, owing to their non-adherence to WHO-CHOICE standards, the results were not comparable to other studies. International surgical trips are expensive. To improve the efficacy and optimal use of limited resources, studies on surgical trips should follow the guidelines set by the WHO-CHOICE.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nolte
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Brianna L
authors.initials: BL
authors.lastname: Maroukis
authors.affiliation: Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room G024W, Ann Arbor, MI, 48109, USA. mahmoudi@med.umich.edu.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
mesh_terms: D003362:Cost-Benefit Analysis / Q000592:standards; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008493:Medical Missions / Q000191:economics*; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D013514:Surgical Procedures, Operative / Q000191:economics*; D014944:World Health Organization