• Adam Gyedu, Cameron Gaskill, Godfred Boakye, and Francis Abantanga.
• Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. drgyedu@gmail.com.
• World J Surg. 2017 Dec 1; 41 (12): 3074-3082.

IntroductionMany low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to assess the cost-effectiveness of surgical outreach missions provided by a wholly local organization in Ghana to highlight the role local groups might play in reducing the unmet surgical need of their communities.MethodsWe calculated the disability-adjusted life years (DALY) averted by surgical outreach mission activities of ApriDec Medical Outreach Group (AMOG), a Ghanaian non-governmental organization. The total cost of their activities was also calculated. Conclusions about cost-effectiveness were made according to World Health Organization (WHO)-suggested parameters.ResultsWe analyzed 2008 patients who had been operated upon by AMOG since December 2011. Operations performed included hernia repairs (824 patients, 41%) and excision biopsy of soft tissue masses (364 patients, 18%). More specialized operations included thyroidectomy (103 patients, 5.1%), urological procedures (including prostatectomy) (71 patients, 3.5%), and plastic surgery (26 patients, 1.3%). Total cost of the outreach trips was $283,762, and 2079 DALY were averted; cost per DALY averted was 136.49 USD. The mission trips were "very cost-effective" per WHO parameters. There was a trend toward a lower cost per DALY averted with subsequent outreach trips organized by AMOG.ConclusionOur findings suggest that providing surgical services through wholly local surgical mission trips to underserved LMIC communities might represent a cost-effective and viable option for countries seeking to reduce the growing unmet surgical needs of their populations.

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