World Journal of Surgery

, Volume 43, Issue 2, pp 353–359 | Cite as

Cost Analysis of the Mongolian ATLS© Program: A Framework for Low- and Middle-Income Countries

  • Jack E. Kornfeld
  • Micah G. Katz
  • James R. Cardinal
  • Batsaikhan Bat-Erdene
  • Gerelmaa Jargalsaikhan
  • Jade NunezEmail author
Original Scientific Report



Trauma is the leading cause of death among Mongolians aged 24–44. To improve initial management of injured patients, the Mongolian National University of Medical Sciences (MNUMS) implemented the American College of Surgeons’ (ACS) Advanced Trauma Life Support (ATLS) training program in 2015. Cost analysis demonstrates that such programs can have clear pathways to self-sufficiency.


Costs associated with an ACS Mongolian ATLS program were quantified based on discussions with the Mongolian government, MNUMS, ATLS Australasia headquarters, and existing pricing data. Costs were then classified as either essential or contingencies. These classifications determined budgetary items for each program. Savings projections for contingencies included training Mongolian instructors and educators. Scenarios for funding the budget were then assessed.


The minimum annual cost of ATLS in Mongolia, which includes 3 ATLS student courses/1 instructor course, is $10,709. A budget of $19,900 includes additional contingencies. The scenario that involves foreign instructors is the most expensive one. An initial investment of $85,000 to train Mongolian instructors reduces annual costs by $48,305 (71% reduction). An investment of $4050 to train a Mongolian educator will reduce costs by $1750 annually. ATLS can be sustained with 0.04% of Mongolia’s current spending on public health and preventative services.


Initial investment to train Mongolian ATLS instructors leads to substantial savings. Training a Mongolian educator lowers long-term costs. When minimum costs for ATLS courses are understood, these can be scaled up and supported with different contingencies and minimal funding by government or third-party stakeholders.



We thank Anudari Zorigtbaatar, Hannah Pioli, Dr. Sergelen Orgoi, Dr. Raymond Price, Dr. Michael Hollands, Lesley Dunstall and Jonathan Nellermoe for expert advice and help with reviewing the manuscript. The study was funded by the Dartmouth Center for Health Equity.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest in the publication of this manuscript.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Jack E. Kornfeld
    • 1
  • Micah G. Katz
    • 2
  • James R. Cardinal
    • 3
  • Batsaikhan Bat-Erdene
    • 4
  • Gerelmaa Jargalsaikhan
    • 4
  • Jade Nunez
    • 2
    • 5
    Email author
  1. 1.Dartmouth Medical SchoolLebanonUSA
  2. 2.Center for Global SurgeryUniversity of UtahSalt Lake CityUSA
  3. 3.School of MedicineUniversity of UtahSalt Lake CityUSA
  4. 4.Department of SurgeryMongolian National University of Medical SciencesUlaanbaatarMongolia
  5. 5.University of UtahSalt Lake CityUSA

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