Global economic burden of unmet surgical need for appendicitis
Anna Reuter, Lisa Rogge, Mark Monahan, Mwayi Kachapila, Dion Morton, Justine Davies, Sebastián Vollmer, AA Essam, Abd Elkhalek Sallam, Abd Elrahman Elshafay, Abd El‐Rahman Hegazy Khedr, Abdalla Gamal Saad, Abdalla Gharib, Abdalla Kenibar, Abdallah Salah Elsherbiny, Abdalrahman Adel, Abdelaziz Abdelaal, Abdelaziz Elhendawy, Abdelfatah Hussein, Abdelkader Belkouchi, Abdelmalek Hrora, Abdelrahman Adelshone, Abdelrahman Alkammash, Abdelrahman Assal, Abdelrahman Geuoshy, Abdelrahman Haroun, Abdelrahman Mohammed, Abdelrahman Sayed, Abdelrahman Soliman, Abdelrhman Essam Elnemr, Abdelrhman KZ Darwish, Abdelrhman Osama Elsebaaye, Abdul Khalique, Abdul Rehman Alvi, Abdul Wahid Anwar, Abdulaziz Altwijri, Abdullah Al‐Mallah, Abdullah Almoflihi, Abdullah Altamimi, Abdullah Daqeeq, Abdullah Dwydar, Abdullah Gouda, Abdullah Hashim, Abdulmalik Altaf, Abdulmalik Huwait, Abdulrahman Abdel‐Aty, Abdulrahman M. Altwigry, Abdulrahman Sheshe, Abdulrasheed A. Nasir, AbdulRazzaq Oluwagbemiga Lawal, Abdulshafi Khaled Abdrabou, Abdurrahaman Sheshe, Abdussemiu Abdurrazzaaq, Abebe Bekele Zerihun, Abeer Al‐shammari, Abeer El Gendy, Abeer Esam, Abeer Marey, Abhishek Mittal, Abiboye Yifieyeh, Abid Bin Mahamood, Abidemi Adesuyi, Abouelatta Khairy Aly, Abrar Nawawi, Adam Gyedu, Ade Waterman, Adedapo Osinowo, Adedeji Fatuga, Adel Albiety, Adel B Hassanein, Adel Denewar, Adeleke Adekoya, Ademola Adebanjo, Ademola Adeyeye, Ademola Popoola, Adesina Adedeji, Adesoji Ademuyiwa, Adesoji Tade, Adewale Adeniyi, Adewale Adisa, Adham Tarek, Adomas Ladukas, Adrian Palma, Afifatun Hasanah, Afizah Salleh, Afnan Abdelfatah, Afnan Altamimi, Afnan Altamini, Agazi Fitsum, Agboola Taiwo, Ahamed Hassan, Ahed Ghaben, Ahmad Abdel Fattah, Ahmad Abdel Razaq Al Rafati, Ahmad Aboelkassem Ibrahem, Ahmad Aldalaq, Ahmad H. Ali, Ahmad Almallah, Ahmad Alrifaie, Ahmad Ashour
Abstract
BACKGROUND: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. METHODS: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. RESULTS: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. CONCLUSION: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.