Purpose
Hand surgery outreach programs to low- and middle-income countries (LMICs) provide
much-needed surgical care to the underserved populations and education to local providers
for improved care. The cost-effectiveness of these surgical trips has not been studied
despite a long history of such efforts. This study aimed to examine the economic impact
of hand surgery trips to LMICs using data from the Touching Hands Project and ReSurge
International. We hypothesized that hand surgery outreach would be cost-effective
in LMICs.
Methods
We analyzed data on the cost of each trip and the surgical procedures performed. Using
methods from the World Health Organization (WHO–Choosing Interventions That Are Cost-Effective
[WHO-CHOICE]), we determined whether the procedures performed during the outreach
trips would be cost-effective.
Results
For the 14 hand surgery trips, 378 patients received surgical treatment. Trips varied
in the country where interventions were provided, the number of patients served, the
severity of the conditions, and the total cost. The cost per disability-adjusted life-year
averted ranged from United States (US)$222 to $1,525, all of which were very cost-effective
according to WHO-CHOICE thresholds. The cost-effectiveness of global hand surgery
was comparable to that of other medical interventions such as multidrug-resistant
tuberculosis treatment in similar regions. We also identified a lack of standardized
record keeping for these surgical trips.
Conclusions
Hand surgeries performed in LMICs are cost-effective based on WHO-CHOICE criteria.
However, a standardized record-keeping method is needed for future research and longitudinal
comparison. Understanding the economic impact of hand surgery global outreach is important
to the success and sustainability of these efforts, both to allocate resources effectively
and to identify areas for improvement.
Type of study/level of evidence
Economic/Decision Analysis III.
Key words
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Article info
Publication history
Published online: December 20, 2018
Accepted:
October 31,
2018
Received:
July 2,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
