Improving access to surgical care for Inuit communities in Nunavik: a cost-savings analysis of a surgeon outreach program

BACKGROUND: Access to timely surgical care in remote regions remains a substantial challenge. We sought to evaluate the societal costs of 2 models for delivering general surgery consultations to Nunavimmiut patients, namely an outreach model involving specialist travel to the Inuulitsivik Health Centre in Puvirnituq, and the traditional model requiring patient transfer to urban tertiary care in Montréal. METHODS: We conducted a cost analysis for all general surgery consultations from May 30, 2022, to May 24, 2024, corresponding to the first 2 years of the specialist travel program. We estimated costs across 4 representative 1-week travel periods. Direct costs included surgeon remuneration, travel, and local service expenses. Indirect costs accounted for lost wages based on the median Nunavik income. Assumptions on travel duration, accommodations, and interpreter services were based on provincial data and Ullivik historical records. RESULTS: The specialist travel model was consistently less costly across all periods analyzed. Patients seen in Puvirnituq incurred lower direct and indirect costs than those transferred to Montréal. The annual cost for urban-based care was $1.86 million compared with $163 000, leading to potential cost savings of $1.7 million annually or $12 000 per consultation. Sensitivity analyses confirmed cost advantages under a broad range of assumptions. CONCLUSION: Deploying specialists to Puvirnituq for surgical consultations is a cost-effective alternative to patient displacement. This model holds promise for improving equitable access to care in remote communities while reducing the financial burden on health care systems.