A material cost-minimization analysis for hernia repairs and minor procedures during a surgical mission in the Dominican Republic

Abstract

INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with α=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions.

International guidelines for groin hernia management

“… 243 While short-term surgical missions have been promoted as a method of alleviating disease burden, the best way for charitable organizations to support surgical care in LRSs is through partnerships with local hernia societies and health practitioners. 243 , 244 Teaching and training local teams should be performed next to alleviate the waiting list. A partnership of this type is occurring presently in Ghana with Operation Hernia http://www.operationhernia.org.uk/ .…”

“… 234 The effectiveness should particularly be evaluated in respect to the retention of surgical skills of the newly trained staff, to improvements in outcomes, and to the retention, in-country, of local healthcare providers. 243 , 244…”

A Systematic Review of Economic Analysis of Surgical Mission Trips Using the World Health Organization Criteria

“…Lastly, we identified four studies using an economic analysis for a combined type of surgical trips (Table 1) [30][31][32][33]. Chen et al, for example, provided orthopedic surgery instruction while simultaneously operating on as many patients as possible in Nicaragua [31].…”

“…Similarly, Moon et al performed cleft lip and palate repair in Vietnam while also teaching local surgeons [30]. Three of the four studies provided a cost-effectiveness measure (DALYs averted) for the surgical services provided [30][31][32], and the fourth study calculated the total economic benefit for surgeries performed over several years [33]. However, none of the studies attempted to calculate the cost-effectiveness of the educative aspect of the trip.…”

Building a Sustainable Global Surgery Nonprofit Organization at an Academic Institution

“…It is a particularly complex process as donations arrive periodically throughout the year from a multitude of sources, thus requiring frequent inventory updates. 5 Volunteer Staffing. Volunteers are key to both fundraising efforts and procurement of supplies, and we employ high school students, community volunteers, and team members to update and document inventory and participate in fundraising efforts.…”