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World J Surg. 2012 Dec;36(12):2802-8. doi: 10.1007/s00268-012-1702-1.

Volunteer orthopedic surgical trips in Nicaragua: a cost-effectiveness evaluation.

Author information

  • 1Institute for Global Orthopedics and Traumatology, University of California at San Francisco, Room 3A36, 1001 Potrero Avenue, San Francisco, CA 94110, USA. andrew_chen@med.unc.edu



Injuries account for a substantial portion of the world's burden of disease and require effective surgical care. Volunteer surgical teams that form partnerships with hospitals help build local surgical capacity while providing immediate care. The purpose of the present study was to evaluate the cost-effectiveness of short orthopedic surgical volunteer trips as a method of reducing the global burden of surgical disease through both surgical and educational interventions.


Data were collected from a scheduled volunteer trip to Leon, Nicaragua, in January 2011 as part of the CooperaciĆ³n OrtopĆ©dica Americano Nicaraguense (COAN), a 501c3 nonprofit organization established in 2002. Costs are from the COAN provider prospective with an additional analysis to include the Nicaraguan provider variable costs. The total burden of musculoskeletal disease averted from the patients receiving surgical intervention was derived using the disability-adjusted-life-years (DALYs) framework and disability weights from the disease control priority project. The cost-effectiveness ratio was calculated by dividing the total costs by the total DALYs averted.


A total of 44.78 DALYs were averted in this study, amounting to an average of 1.49 DALYs averted per patient. The average cost per patient from the COAN provider perspective was $525.64, and from both the COAN and Nicaraguan provider perspective it was $710.97. In the base case, cost-effectiveness was $352.15 per DALY averted, which is below twice the Nicaraguan per capita gross national income ($652.40).


Volunteer orthopedic surgical trips are cost-effective in Nicaragua. Further research should be conducted with multiple trips and with different patient populations to test the generalizability of the results.

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