Global economic consequences of selected surgical diseases: a modelling study.
BACKGROUND
The surgical burden of disease is substantial, but little is known about the associated economic consequences. We estimate the global macroeconomic impact of the surgical burden of disease due to injury, neoplasm, digestive diseases, and maternal and neonatal disorders from two distinct economic perspectives.


METHODS
We obtained mortality rate estimates for each disease for the years 2000 and 2010 from the Institute of Health Metrics and Evaluation Global Burden of Disease 2010 study, and estimates of the proportion of the burden of the selected diseases that is surgical from a paper by Shrime and colleagues. We first used the value of lost output (VLO) approach, based on the WHO's Projecting the Economic Cost of Ill-Health (EPIC) model, to project annual market economy losses due to these surgical diseases during 2015-30. EPIC attempts to model how disease affects a country's projected labour force and capital stock, which in turn are related to losses in economic output, or gross domestic product (GDP). We then used the value of lost welfare (VLW) approach, which is conceptually based on the value of a statistical life and is inclusive of non-market losses, to estimate the present value of long-run welfare losses resulting from mortality and short-run welfare losses resulting from morbidity incurred during 2010. Sensitivity analyses were performed for both approaches.


RESULTS
During 2015-30, the VLO approach projected that surgical conditions would result in losses of 1·25% of potential GDP, or $20·7 trillion (2010 US$, purchasing power parity) in the 128 countries with data available. When expressed as a proportion of potential GDP, annual GDP losses were greatest in low-income and middle-income countries, with up to a 2·5% loss in output by 2030. When total welfare losses are assessed (VLW), the present value of economic losses is estimated to be equivalent to 17% of 2010 GDP, or $14·5 trillion in the 175 countries assessed with this approach. Neoplasm and injury account for greater than 95% of total economic losses with each approach, but maternal, digestive, and neonatal disorders, which represent only 4% of losses in high-income countries with the VLW approach, contribute to 26% of losses in low-income countries.


CONCLUSIONS
The macroeconomic impact of surgical disease is substantial and inequitably distributed. When paired with the growing number of favourable cost-effectiveness analyses of surgical interventions in low-income and middle-income countries, our results suggest that building surgical capacity should be a global health priority.


BACKGROUND
US National Institutes of Health/National Cancer Institute.
Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA. Electronic address: blakealkire@gmail.com.
Blake C
BC
Alkire
Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard School of Public Health, Cambridge, MA, USA.
Mark G
MG
Shrime
King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
Anna J
AJ
Dare
Nicholas School of the Environment and Sanford School of Public Policy, Duke University, Durham, NC, USA.
Jeffrey R
JR
Vincent
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Plastic and Reconstructive Surgery, Boston Children's Hospital, Boston, MA, USA.
John G
JG
Meara
D017281:Cost of Illness; D004066:Digestive System Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery; D014943:Global Health; D059066:Gross Domestic Product; D005102:Health Expenditures; D006801:Humans; D008427:Maternal Health Services / Q000191:economics; D009369:Neoplasms / Q000191:economics / Q000378:metabolism / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality / Q000601:surgery