Title : Cost- Effective analysis of the cinterandes mobile surgical unit

Background: Approximately 5 billion people lack access to affordable and timely surgical care with the majority of these populations living in rural or resource limited setting. In Ecuador, geographical barriers and limited surgical infrastructure restrict access for many populations outside major urban centers. The Cinterandes Foundation addresses this disparity through a mobile surgical unit equipped with a fully functional operating room that travels to underserved communities around the country. This study evaluates the cost-effectiveness, geographic reach, and global health implications of the Cinterandes mobile surgical model in reaching rural populations in Ecuador.  

Methods: A retrospective cost-effectiveness analysis was conducted on 6,348 major surgical procedures performed by the Cinterandes mobile surgical unit between 1994 and 2025 with complete financial records. Procedure costs were compared with estimates from Ecuadorian public hospitals and GDP-adjusted U.S. hospital costs. Health impact was quantified using disability-adjusted life years (DALYs) prevented, calculated using Global Burden of Disease disability weights and conservative estimates of untreated disease duration. Cost per DALY prevented was used as the primary metric of economic efficiency and compared with procedure costs in Ecuadorian and U.S. hospitals. 

Results: Between 1994 and 2025, the Cinterandes program performed 6,348 surgeries across 122 locations in Ecuador, with a substantial proportion occurring in rural communities with limited baseline surgical access. Compared with Ecuadorian public hospitals, the mobile surgical unit reduced procedure costs by 52.5% to 95.9%. The analyzed procedures were estimated to prevent approximately 4,116 DALY or disability adjusted life years. Total program costs of approximately $1.35 million yielded an estimated cost per DALY prevented of $328. The cost per DALY prevented value of $328 recovered by the Cinterandes program the mobile surgical program falls well below commonly used thresholds for high cost-effectiveness which is <$6,353, Ecuador’s 2023 GDP per capita. This findings is consistent with the broader global surgery literature that finds many essential surgical interventions are highly cost-effective in LMIC settings Hernia repair, laparoscopic cholecystectomy, and orchiopexy accounted for the largest share of disability reduction due to high surgical volume and substantial functional benefit. 

Conclusion: The Cinterandes mobile surgical program demonstrates that mobile surgical infrastructure can deliver high-volume essential surgery with substantial cost savings and measurable population health impact. By reducing infrastructure costs and overcoming geographic barriers, this model offers a scalable strategy for expanding surgical access in lowresource settings. Integration of mobile surgical units into national health systems may represent a viable pathway toward increasing access to essential surgical care.  

Juliet Johnson is a second-year medical student at the Medical University of South Carolina (MUSC) with interests in global surgery and expanding access to surgical care in rural and underserved populations through technological innovation. She holds a Bachelor of Science in Biochemistry and Molecular Biology from Wake Forest University, where she conducted research on the electrical properties of phospholipid membranes in Jurkat cell lines. At MUSC, she serves as Director of the MUSC Global Surgery Newsletter and Secretary/Treasurer for the Class of 2028. Her clinical interests include general surgery, interventional radiology, and ophthalmology.