J. E. Kornfeld1, M. Katz6, J. R. Cardinal7, B. Bat-Erdene3, G. Jargalsaikhan3, J. Nellermoe2, L. A. Dunstall8, M. Holland8, A. Zorigtbaatar9, H. Pioli7, S. Orgoi3,5, J. Nunez6, R. Price2,6 1Dartmouth Medical School,Lebanon, NH, USA 2University Of Utah,Center For Global Surgery,Salt Lake City, UT, USA 3Mongolian National University Of Medical Sciences,Department Of Surgery,Ulaanbaatar, , Mongolia 5WHO Collaborating Center For Essential Emergency And Surgical Care,Ulaanbaatar, , Mongolia 6University Of Utah,Department Of General Surgery,Salt Lake City, UT, USA 7University Of Utah,Salt Lake City, UT, USA 8Westmead Hospital,Sydney, NSW, Australia 9McGill University,Montreal, QC, Canada
Introduction: In the last two decades the burden of trauma has increased in Mongolia; trauma is now the number one cause of death amongst Mongolians aged 24-44. In 2015, the Mongolian National University of Medical Sciences (MNUMS), in partnership with the American College of Surgeons, implemented an Advanced Trauma Life Support (ATLS) training program. According to the Disease Control Priorities, organized trauma systems have been associated with a decrease in mortality and the economic burden of trauma. ATLS in Mongolia has been shown to have a positive impact on confidence and self-reported clinical competencies in the context of trauma care. The cost of ATLS continues to be a challenge for promulgating ATLS in low- and middle-income countries (LMICs). A cost-analysis for continued development and expansion of ATLS in Mongolia, a LMIC, might provide a framework for expanding self-sustaining ATLS programs in other LMICs.
Methods: All costs associated with a Mongolian ATLS program were identified and quantified based on discussions with the Mongolian government, MNUMS, ATLS Australasia headquarters and existing pricing data. Costs were then classified either as essential or contingencies. A basic minimum budget was constructed. Costs were considered contingencies if they represented components of the course that have yet to be established (training a Mongolian educator, supporting ATLS directors and coordinators to attend regional and international ATLS meetings, ATLS updates/translations). Budget scenarios were developed with various combinations of contingencies and the basic minimum budget. Savings projections were calculated for enacting contingencies that included training Mongolian instructors and educators.
Results: The modeling shows the minimum annual cost of ATLS in Mongolia to be $10,700 (three ATLS student courses). A more comprehensive budget of $19,900 includes additional contingencies. Since beginning the program in 2015, an initial investment of $85,000 to train Mongolian instructors reduced instructor costs by $49,600 per year for a cost reduction of 79.6% and will be paid back within two years. An initial investment of $4,050 to train a Mongolian educator will reduce educator costs by $1,750 per year; this initial investment will be paid back within 2.1 years.
Conclusion: The cost-analysis of ATLS in Mongolia demonstrates that the initial investment to train Mongolian instructors led to substantial savings. Further investment to train a Mongolian educator will also lead to lower long-term costs. A minimal cost for the ATLS course was determined, which can be scaled up with different contingencies. We believe this is the first cost-analysis performed for a government-supported ATLS program.
