A Procedural Cost Minimization Analysis for Hernia Repairs and Minor Procedures Between a United States Academic Institution and a Medical Mission to the Dominican Republic

Jaime A Cavallo, MD, MPHS, Jenny Ousley, BS, Christopher Barrett, MD, Sara Baalman, MA, Kyle Ward, DO, Margaret M Frisella, RN, Brent D Matthews, MD

Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri

INTRODUCTION: Material supplies and medications constitute the greatest per capita costs for surgical missions to underserved populations. Nonprofit organizations that provide healthcare materials have the potential to minimize procedural costs and increase the number of patients served during limited-budget surgical missions. We hypothesize that supply acquisition at nonprofit organization (NPO) costs will lead to significant cost-savings compared to supply acquisition at US academic institution (USAI) costs from the provider perspective for hernia repairs and minor procedures during a surgical mission.

METHODS: Individual items acquired for a surgical mission to the Dominican Republic (DR) in 2012 were uniquely barcoded for accurate accounting of consumption. Traceability Made Easy® (MASS Group®, Inc.) software was used to generate a custom inventory system. Both the NPO and the USAI unit costs were associated with each item in the inventory. For each procedure sampled, barcodes for all used items were scanned and assigned to the corresponding procedure record. Doses for all administered medications were recorded and assigned to the corresponding procedure record. Mean material costs for each procedure type were calculated, and a cost-minimization analysis between the NPO and the USAI platforms ensued. A two-tailed Wilcoxon matched-pairs test was applied to each set of costs at a significance level of α=0.05. Results are presented as means ± SDs, and all costs are presented in US dollars. To reproduce our mission experience, item utilization analysis was used to generate lists of most frequently used materials by procedure type.

RESULTS: A total of 126 procedures were performed on 110 patients (M:F= 80:30; age= 45.6 ± 20.4 years). Sampled among these procedures were 13 unilateral inguinal hernia repairs (IHR), 3 bilateral inguinal hernia repairs (BIHR), 9 hydrocelectomies (HC), 3 femoral hernia repairs (FHR), 8 umbilical hernia repairs (UHR), 26 minor procedures (MP) including excisions of benign superficial masses, and 7 pediatric inguinal hernia repairs (PIHR). For each procedure type, the mean material costs under the NPO versus the USAI platforms, respectively, and the mean cost savings (CS) were as follows: IHR: $62.17 ± $0.74 versus $502.79 ± $684.51 (p=0.0002), CS=$482.86 ± $683.79; BIHR: $51.85 ± $26.87 versus $351.27 ± $184.20 (p=0.2500), CS=$332.46 ± $184.09; HC: $53.73 ± $23.66 versus $141.68 ± $14.11 (p=0.0039), CS=$127.26 ± $13.18; FHR: $55.47 ± $13.44 versus $253.81 ± $54.32 (p=0.2500), CS=$232.92 ± $56.49; UHR: $47.56 ± $31.35 versus $133.05 ± $31.54 (p=0.0078), CS=$120.90 ± $30.51; MP: $4.59 ± $13.34 versus $38.55 ± $19.03 (p<0.0001), CS=$36.59 ± $17.76; PIHR: $23.92 ± $11.49 versus $134.22 ± $16.61 (p=0.0156), CS=$120.66 ± $14.61. Notably, NPO costs exceeded USAI costs for narcotics, antibiotics, and normal saline.

CONCLUSION: Supply acquisition at nonprofit organization 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.

Session: Podium Presentation

Program Number: S026

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