The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures.

Autor:	Adde HA; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway haavarad@stud.ntnu.no.; Department of Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.; CapaCare, Trondheim, Norway, & Tappita, Liberia., Oghogho MD; CapaCare, Trondheim, Norway, & Tappita, Liberia., van Duinen AJ; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.; CapaCare, Trondheim, Norway, & Tappita, Liberia.; Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.; Department of Surgery, ELWA Hospital, Monrovia, Liberia., Grimes CE; King's Centre for Global Health and Health Partnerships, King's College, London, UK.; Medway NHS Foundation Trust, Gillingham, UK., Hampaye TC; Physician Assistant Association, Monrovia, Liberia., Quaife M; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.; Evidera Ltd, London, UK., Bolkan HA; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.; CapaCare, Trondheim, Norway, & Tappita, Liberia.; Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Jan 08; Vol. 14 (1), pp. e076293. Date of Electronic Publication: 2024 Jan 08.
DOI:	10.1136/bmjopen-2023-076293
Abstrakt:	Objectives: The economic consequences of untreated surgical disease are potentially large. The aim of this study was to estimate the economic burden associated with unmet surgical needs in Liberia. Design: A nationwide enumeration of surgical procedures and providers was conducted in Liberia in 2018. We estimated the number of disability-adjusted life years (DALYs) saved by operative activities and converted these into economic losses averted using gross national income per capita and value of a statistical life (VSL) approaches. The total, the met and the unmet needs for surgery were determined, and economic losses caused by unmet surgical needs were estimated. Finally, we valued the economic losses avoided by various surgical provider groups. Results: A total of 55 890 DALYs were averted by surgical activities in 2018; these activities prevented an economic loss of between US$35 and US$141 million. About half of these values were generated by the non-specialist physician workforce. Furthermore, a non-specialist physician working a full-time position for 1 year prevented an economic loss of US$717 069 using the VSL approach, while a specialist resident and a certified specialist saved US$726 606 and US$698 877, respectively. The burden of unmet surgical need was associated with productivity losses of between US$388 million and US$1.6 billion; these losses equate to 11% and 46% of the annual gross domestic product for Liberia. Conclusion: The economic burden of untreated surgical disease is large in Liberia. There is a need to strengthen the surgical system to reduce ongoing economic losses; a framework where specialist and non-specialist physicians collaborate may result in better economic return than a narrower focus on training specialists alone. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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