Effectiveness, cost-effectiveness, and economic impact of a multi-specialty charitable surgical center in Honduras

Introduction: Despite significant demand and evidence indicating cost-effectiveness, surgical care is neglected in low- and middle-income countries (LMIC). Research indicates complex charitable surgical interventions are more effective in specialty hospitals than in short-term mission trips. This study aims to determine the effectiveness, cost-effectiveness, and economic impact of a multi-specialty charitable ambulatory surgical center in a LMIC. Materials and methods: Surgeries performed at an ambulatory surgery center (ASC) in rural Honduras in six specialties were evaluated for a one-year period for complications, infections, and patient satisfaction. Each patient's decrease in disability was determined by the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and these data were used to estimate the cost per Disability Adjusted Life Year (DALY) averted. Economic benefit was calculated by the human capital approach and the value of a statistical life (VSL) approach. Results: Of the 963 surgeries performed, four patients (0.4%) experienced surgical site infections and 16 (1.6%) experienced complications, comparable to rates at ASCs in high-income countries. Cost per DALY averted was $638.08. The economic benefit was $17.9 million using the human capital approach and $328.4 million using the VSL approach. Conclusions: Our findings suggest a multi-specialty charitable surgical center in a low-middle income country can achieve similar outcomes to surgery centers in high-income countries. The operations were slightly less cost-effective than many short-term surgical missions, likely due to the investment in equipment and local labor which leads to the more favorable outcomes. This model of charitable surgical care provides a substantial benefit to the population. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.