Global economic burden of unmet surgical need for appendicitis

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.

Fig. 1

Calculation of expected mortality risk and number of absent days a Resulting from not providing surgery to the local standard, and b resulting from not providing surgery to the highest standard. *Non-fatal cases. †Assuming that all patients with appendicitis undergo surgery in high-income countries (HICs), such that D = 0. LMICs, low- and middle-income countries; n.a., not applicable.

Fig. 2

Estimated share of unmet need in 2015 by country Calculated using a approach 1 and b approach 2. Approach 1 calculates unmet need for appendicitis assuming that the proportion of this unmet need is equivalent to the unment need for all conditions requiring surgery. Approach 2 calculates unmet need as the relative difference of estimated number of appendicectomies (calculated as World Bank income group-specific share of surgical volume) to the number of appendicitis cases.

Fig. 3

Composition of economic burden Economic burden is expressed in 2015 US dollar purchasing power parity. Approach 1 calculates unmet need as the relative difference of surgical volume to the minimum surgical volume proposed by the Lancet Commission on Global Surgery. Approach 2 calculates unmet need as the relative difference of estimated number of appendicectomies (calculated as World Bank income group-specific share of surgical volume) to the number of appendicitis cases.