Scientific Article| Volume 48, ISSUE 3, P310.e1-310.e11, March 2023

Cost-Effectiveness of Pediatric Hand International Medical Missions

Published:December 18, 2021DOI:


      Limited access and resources in low- and middle-income countries leave many individuals deprived of medical care. Surgical mission trips offer a solution to provide sound surgical care to underserved areas but require a sizable financial support. Previous analyses of such trips have not included values of donated supplies and costs borne by the host country. We hypothesized that the orthopedic mission trips, utilizing the World Pediatric Project (WPP) model, can be executed in a cost-effective manner according to the World Health Organization thresholds even when considering cost to the organizations and host country.


      World Pediatric Project records for the most recent pediatric upper extremity orthopedic mission trips of 2016, 2018, and 2019 were obtained. Cost estimates were based on documentation from each of the mission trips. Total costs included the costs borne by the WPP, estimates of the value of donated supplies, and costs borne by the host country. The cost-effectiveness of the surgical mission trips was determined by the total cost and potential benefit of performing the orthopedic surgeries using disability-adjusted life years averted.


      Three separate mission trips to St. Vincent and the Grenadines were analyzed. Forty-five pediatric patients had received surgical care. The cost was calculated to be $431.50 per disability-adjusted life years averted when only the WPP costs are considered; including donated supplies and cost borne by the host country in the total cost, the cost was $6898.10 per disability-adjusted life years averted. After comparing the cost values to the per capita gross domestic product of St. Vincent and the Grenadines, $7,463.54, the WPP mission trips were determined to be cost-effective according to the WHO-CHOICE thresholds in all 5 categories.


      Orthopedic medical mission trips can provide cost-effective surgical treatments for the upper extremity even when the costs to the organization and host country and trip donations are considered.

      Type of study/level of evidence

      Economic/Decision Analysis III.

      Key words

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        • Meara J.G.
        • Greenberg S.L.
        The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development.
        Surgery. 2015; 157: 834-835
        • Grimes C.E.
        • Henry J.A.
        • Maraka J.
        • Mkandawire N.C.
        • Cotton M.
        Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.
        World J Surg. 2014; 38: 252-263
        • Gyedu A.
        • Gaskill C.
        • Boakye G.
        • Abantanga F.
        Cost-effectiveness of a locally organized surgical outreach mission: making a case for strengthening local non-governmental organizations.
        World J Surg. 2017; 41: 3074-3082
        • United Nations
        Office of the High Representative for the Least Developed Countries Landlocked Developing Countries and the Small Island Developing States. About the small island developing states.
        (Accessed November 30, 2019)
        • Ozgediz D.
        • Jamison D.
        • Cherian M.
        • McQueen K.
        The burden of surgical conditions and access to surgical care in low- and middle-income countries.
        Bull World Health Organ. 2008; 86: 646-647
        • Davis M.C.
        • Than K.D.
        • Garton H.J.
        Cost effectiveness of a short-term pediatric neurosurgical brigade to Guatemala.
        World Neurosurg. 2014; 82: 974-979
        • Shillcutt S.D.
        • Sanders D.L.
        • Teresa Butron-Vila M.
        • Kingsnorth A.N.
        Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador.
        World J Surg. 2013; 37: 32-41
        • Fung A.
        • Horton S.
        • Zabih V.
        • Denburg A.
        • Gupta S.
        Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review.
        BMJ Glob Health. 2019; 4e001825
        • Qiu X.
        • Nasser J.S.
        • Sue G.R.
        • Chang J.
        • Chung K.C.
        Cost-effectiveness analysis of humanitarian hand surgery trips according to WHO-CHOICE thresholds.
        J Hand Surg Am. 2019; 44: 93-103
        • Tadisina K.K.
        • Chopra K.
        • Tangredi J.
        • Thomson J.G.
        • Singh D.P.
        Helping hands: a cost-effectiveness study of a humanitarian hand surgery mission.
        Plast Surg Int. 2014; 2014: 921625
      1. World Pediatric Project.
        (Accessed September 12, 2020)
        • Robberstad B.
        QALYs vs DALYs vs LYs gained: what are the differences, and what difference do they make for health care priority setting?.
        Norsk Epidemiol. 2005; 15: 183-191
        • Gold M.R.
        • Stevenson D.
        • Fryback D.G.
        HALYS and QALYS and DALYS, oh my: similarities and differences in summary measures of population health.
        Annu Rev Public Health. 2002; 23: 115-134
        • Murray C.J.
        • Evans D.B.
        • Acharya A.
        • Baltussen R.M.
        Development of WHO guidelines on generalized cost-effectiveness analysis.
        Health Econ. 2000; 9: 235-251
        • World Health Organization (Geneva)
        WHO guide to cost-effectiveness analysis.
        (Accessed September 20, 2020)
        • Nolte M.T.
        • Maroukis B.L.
        • Chung K.C.
        • Mahmoudi E.
        A systematic review of economic analysis of surgical mission trips using the World Health Organization criteria.
        World J Surg. 2016; 40: 1874-1884
        • Murray C.J.L.
        • Vos T.
        • Lozano R.
        • et al.
        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2197-2223
        • World Health Organization
        Global Health Estimates: Life Expectancy and Leading Causes of Death and Disability.
        (Accessed August 18, 2020)
        • Gosselin R.A.
        • Gialamas G.
        • Atkin D.M.
        Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries.
        World J Surg. 2011; 35: 951-955
        • Woods B.
        • Revill P.
        • Sculpher M.
        • Claxton K.
        Country-level cost-effectiveness thresholds: initial estimates and the need for further research.
        Value Health. 2016; 19: 929-935
        • World Health Organization
        Saint Vincent and the Grenadines.
        (Accessed August 18, 2020)
        • The World Bank
        GDP Per Capita-St. Vincent and the Grenadines.
        (Accessed August 18, 2020)