Global economic burden of unmet surgical need for appendicitis
Authors: Reuter Anna , Rogge Lisa , Monahan Mark , Kachapila Mwayi , Morton Dion G , Davies Justine , Vollmer Sebastian ,   NIHR Global Surgery Collaboration, Essam AA , Sallam Abd Elkhalek , Elshafay Abd Elrahman , Khedr Abd El-Rahman Hegazy , Saad Abdalla Gamal , Gharib Abdalla , Kenibar Abdalla , Elsherbiny Abdallah Salah , Adel Abdalrahman , Abdelaal Abdelaziz , Elhendawy Abdelaziz Osman Abdelaziz , Hussein Abdelfatah , Belkouchi Abdelkader , Hrora Abdelmalek , Adelshone Abdelrahman , Alkammash Abdelrahman , Assal Abdelrahman , Geuoshy Abdelrahman , Haroun Abdelrahman , Mohammed Abdelrahman , Sayed Abdelrahman , Soliman Abdelrahman , Elnemr Abdelrhman Essam , Darwish Abdelrhman KZ , Elsebaaye Abdelrhman Osama , Khalique Abdul , Alvi Abdul Rehman , Anwar Abdul Wahid , Altwijri Abdulaziz , Al-Mallah Abdullah , Almoflihi Abdullah , Altamimi Abdullah , Daqeeq Abdullah , Dwydar Abdullah , Gouda Abdullah , Hashim Abdullah , Altaf Abdulmalik , Huwait Abdulmalik , Abdel-Aty Abdulrahman , Altwigry Abdulrahman M. , Sheshe Abdulrahman , Nasir Abdulrasheed A , Lawal AbdulRazzaq Oluwagbemiga , Abdrabou Abdulshafi Khaled , Sheshe Abdurrahaman , Abdurrazzaaq Abdussemiu , Zerihun Abebe Bekele , Al-shammari Abeer , Gendy Abeer El , Esam Abeer , Marey Abeer , Mittal Abhishek , Yifieyeh Abiboye , Mahamood Abid Bin , Adesuyi Abidemi , Aly Abouelatta Khairy , Nawawi Abrar , Gyedu Adam , Waterman Ade , Osinowo Adedapo , Fatuga Adedeji , Albiety Adel , Hassanein Adel B , Denewar Adel , Adekoya Adeleke , Adebanjo Ademola , Adeyeye Ademola , Popoola Ademola , Adedeji Adesina , Ademuyiwa Adesoji O , Tade Adesoji , Adeniyi Adewale , Adisa Adewale O , Tarek Adham , Ladukas Adomas , Palma Adrian F. , Hasanah Afifatun , Salleh Afizah , Abdelfatah Afnan , Altamimi Afnan , Altamini Afnan , Fitsum Agazi , Taiwo Agboola , Hassan Ahamed , Ghaben Ahed , Fattah Ahmad Abdel , Rafati Ahmad Abdel Razaq Al , Ibrahem Ahmad Aboelkassem , Aldalaq Ahmad , Ali Ahmad , Almallah Ahmad , Alrifaie Ahmad , Ashour Ahmad , Bakr Ahmad , Bani-Sadar Ahmad , Adnan Ahmad Bin , Elbatahgy Ahmad , Faraz Ahmad , Gudal Ahmad , Hasan Ahmad , Sabe Ahmad Khaled , Khoja Ahmad , Nashaat Ahmad , Qaissieh Ahmad , Sabe Ahmad , Sleem Ahmad Saber , Sakr Ahmad , Shalabi Ahmad , Qureshi Ahmad Uzair , Aamer Ahmed , Galeel Ahmed Abd El , Elhusseiny Ahmed Abd Elmoen , Elsameea Ahmed Abd , Abdelkareem Ahmed , Ghazy Ahmed Abdelmotaleb , Magd Ahmed Abo El , Elazayem Ahmed Abo , Adamu Ahmed , Adel Ahmed , Afandy Ahmed , Ahmed Ahmed , Alghamdi Ahmed , Ali Ahmed , Al-khatib Ahmed , Altibi Ahmed , Alzahrani Ahmed , Ata Ahmed , Badr Ahmed , Dahy Ahmed , Diab Ahmed , Kashash Ahmed El , Kholy Ahmed El , Musa Ahmed Elgaili Khalid , Elgebaly Ahmed , Elkelany Ahmed , Elkholy Ahmed , El-Sehily Ahmed , Essam Ahmed , Fahiem Ahmed , Farag Ahmed , Fawzy Ahmed , Fouad Ahmed , Gad Ahmed , Ghanem Ahmed , Gheith Ahmed , Gomaa Ahmed , Kotb Ahmed Hafez El-Badri , Hammad Ahmed , Hassan Ahmed , Rida Ahmed Hossam Eldin Fouad , Ismail Ahmed , Karim Ahmed , Khyrallh Ahmed , Lasheen Ahmed , Rashed Ahmed M. , Magdy Ahmed , Abdelraouf Ahmed Mahmoud , Menshawy Ahmed , Meshref Ahmed , Afifi Ahmed Mohamed , Ibrahim Ahmed mohamed , Mohameden Ahmed , Mohammed Ahmed , Mokhtar Ahmed , Mosad Ahmed , Moustafa Ahmed , Saeed Ahmed Moustafa , Negida Ahmed , Mohammed Ahmed Rabeih , Mohamed Ahmed Rabie , Nayel Ahmed Ragab , Soliman Ahmed Ragab , Raslan Ahmed , Raza Ahmed , Refaat Ahmed , Rslan Ahmed , Sabry Ahmed , El-Hamouly Ahmed Sabry , Marey Ahmed Safwan , Saidbadr Ahmed , Sakr Ahmed , Samir Ahmed , Shahine Ahmed , Sheta Ahmed , Soliman Ahmed , Tammam Ahmed , Hassan Ahmed Tarek Abdelbaset , Shamsedine Ahmed W. , Zaki Ahmed , Eldeeb Ahmed Zaki , Zohair Ahmed , Kandil Ahmedali M , Elnagar Ahmedglal , Zil-E-Ali Ahsan , Jabbar Aijaz , Snaith Ailsa Claire , Costas-Chavarri Ainhoa , Austraite Aiste , Mistry Ajayesh , Olaolorun Akin , Ajao Akinlabi E , Jubran Al Faifi , Shamasneh Ala , Abouelnasr Alaa , Al-Buhaisi Alaa , Bowabsak Alaa , 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Cheah Alvin Ee Zhiun , Elrazek Aly Abd , Nasr Aly , Sanad Aly , Elgendy Alyaa Halim , Cury Alyne Daltri Lazzarini , Ibrahim Amal , Martin Amandine , Althwainy Amani , Abouzahra Amany , Mohammed Amany Eldosouky , Kourdouli Amar , Hashish Amel , Birring Amerdip , Meligy Amgad Al , Abdelhamid Amina , Majid Aminah Hanum Haji Abdul , Mohammad Aminu , Kaci Amir Ait , Omar Amira Atef , Elsawy Amira , Bekhet Amira Hassan , Reda Amira , Qumbos Amjad Abu , Elmashala Amjad , Gado Ammar , Mohamed Amna Mamdouh , Mohamed Amna , Rasendran Amoudtha , Saleh Amr Ahmed , Fadel Amr , Hasan Amr , Hassaan Amr , Hossameldin Amr , Elkorashy Amr Muhammad , Hafez Amr Tarek , Faruq Amreen , Aglan Amro , Bautista Ana Cecilia Manchego , Contreras-Vergara Ana Lucia , Barrantes Ana Maria Sandoval , Freitas Ana Vega Carreiro De , Freitas Ana Vega , Rashid Anam , Abdelazeam Anan Rady , Kirishnan Anand , Majbar Anass , Bamicha Anastasia , Stefanopoulos Anastasios , Thorell Anders , Das Andre , Dubois Andre , Mihaljevic Andre L , Navarro Andre , Allegri Andrea , Armellini Andrea , Belli Andrea , Bondurri Andrea , Moran Andrea Echevarria Rosas , Natili Andrea , Ruzzenente Andrea , Simioni Andrea , Haloho Andreass , Tanase Andrei , Kolosov Andrej , Subocius Andrejus , Robertson Andrew G N , Kirby Andrew , Mcguigan Andrew , Spina Andrew , Litvin Andrey , Burmistrovas Andrius , Strazdas Andrius , Arenas Andy , Bhangu Aneel , Rudzenskaite Anele , Rojas Angel David Pérez , Dell Angela , Mejia Angelica Genoveva Vergara , Charles Angeline , Antoniozzi Angelo , Benevento Angelo , Tselos Angelos , El-Ma'doul Angham Solaiman , Sreedharan Anjana , Bhatnagar Ankur , Kjellin Ann , Lasek Anna , Maffioli Anna , Powell Anna , Rinaldi Anna , Watts Anna , Conte Annalisa lo , Bigaran Annamaria , Ashton Annelisse , Mukin Annisa Dewi Fitriana , Gulbinas Antanas , Zadoroznas Antanas , Rulie Anthonius Santoso , Ajiboye Anthony , Avoka Anthony , Lai Anthony Chuk-Him , Davor Anthony , Sander Anthony , Oosterkamp Antje , Bediako-Bowan Antoinette , Brocca Antonella La , Leal Antônio , Nocito Antonio , Medina Antonio Ramos-De La , Taddei Antonio , Atiyeh Anwar , Kojo Anyomih Theophilus Teddy , Driscoll Aoife , Shah Apar , Vlachogiorgos Apostolos , Roslani April Camilla , Abdelhaq Aram , Paucar Arazzelly del Pilar , Picciariello Arcangelo , Tarek Areej , Kanani Arezo , Leppäniemi Ari , Birindelli Arianna , Ibrahim Arij , Nesaratnam Arjun , Suyadi Arlindawati , Velásquez Armando José Román , Bonnard Arnaud , Agarwal Arnav , Alkaaki Aroub , Vaicius Arturas , Khamajeet Arvin , Reinsoo Arvo , Abouzaid Arwa , Elfarargy Arwa , Ibrahim Arwa , Mohamed Arwa , Kedar Asaf , Ahmed Asdaq , Ali Ased , Alnusairat Aseel , Hamarshi Aseel , Musleh Aseel , Prabhudesai Ash , Maghrabi Ashraf A. , Morsi Ashraf , Mitul Ashrarur Rahman , Abdelgelil Asmaa , Al-Aarag Asmaa Abdel-Rahman , Rezq Asmaa , Salah Asmaa , Papailia Aspasia , Badwy Assmaa , Leusink Astrid , Khan Ata , Ahmed Ataa , Bamicha Athanasia , Eysa Athar , Zulkifli Athirah , Mahdi Atif , Attia Attia , Attia Attia Mohamed , Clarissa Audrey , Dulskas Audrius , Parseliunas Audrius , Zani Augusto , Tun Aung Kyaw , Mironescu Aurel , Mironescu Aurel Sandu , Scalabre Aurelien , Mariani Aurora , Haffreingue Aurore , Thollot Aurore , Usaityte Ausrine , Skardžiukaitė Austė , Raza Awais , Ibraheem Aya Abdel Fatah , Aboarab Aya , Elsharkawy Aya Adel , El-Sawy Aya , Elwaey Aya , Firwana Aya , Hagar Aya , Hammad Aya , Fathy Aya Mohamed , Reda Aya , Ata Aya Yehia , Hamdan Ayah , Hassaan Ayat , Taher Ayman And , Elwan Ayman , Nabawi Ayman , Salman Ayman , Shwky Ayman , Ogunyemi Ayokunle , Herebat Azher , Verjee Azmina , Adenekan Babajide , Odeyemi Babatunde , Adel Badr Eldin , Tawfik Badreldin Adel , Ozkan Bahar Busra , Mohamed Bakeer , Nighat Bakhtiar , Albeladi Bandar , Málaga Bárbara , Mijuskovic Barbara , Silvestre Barbara Pereira , Kumar Basant , Sieda Basem , Bello Bashir , Alghamdi Basim , Magdy Basma , Mahmoud Basma , Alhassan Basmah , Mowafy Bassant , 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Altaf , Razi Syed Asaat ul , Lemaire Sylvia Batista , Mochet Sylvie , Rekhis Syrine , Widiastini T Ariani , Ngwa Tagang Ebogo , Yusufali Taha , Al-taher Taher , Yaseen Tahir Muhammad , Yaseen Tahir , Naqvi Tahira , Lawal Taiwo Akeem , Lawal Taiwo , Arulampalam Tan , Gala Tanzeela , Kumar Tapan , Grima Tara , Ezzat Tarek , Razek Tarek , Idress Tasneem , Kanta Tasnia Hamid , Shachykava Tatsiana , Khan Taufiq , Ali Tebian Hassanein Ahmed , Fautz Tessa , Worku Tewodros , Nouh Thamer , Pugliesi Thays Brunelli , Dimech Thea , Tembo Thelma , Xerri Thelma , Pezas Theodore , Theodosopoulos Theodosios , Giuriato Thiago Fernandes , Alihonou Thierry , Feidantsis Thomas , Fozard Thomas , Weiser Thomas G , Drake Thomas M , Olajide Thomas Olagboyega , Pinkney Thomas , Prudhomme Thomas , Sherman Thomas , Moe Thomas Tetens , Alzayat Thuraya , Hettiarachchi Thusitha Sampath , Lee Tien Seng Bryan , White Timothy , Gaarder Tina , Schuetz Tobias , Tolotra Todisoa Emmanuella Christina , Cecilia Tolg , Malik Tom AM , Arthur Tom , Hall Tom Falconer , Abaliksta Tomas , Jankus Tomas , Poškus Tomas , Bocchetti Tommaso , Campagnaro Tommaso , Fontana Tommaso , Mak Tony , Khafagy Toqa , Veen Torhild , Wold Trude Beate , Chan Tsz-Yan Katie , Mat Tuan Nur'Azmah Tuan , Sholadoye Tunde , Mak TWC , Rouse Tyler , Chen Tzu-Ling , Muddebihal Uday , Karabacak Ufuk , Gunnarsson Ulf , Gustafsson Ulf , Muktar Umar , Tedeschi Umberto , Salma Umme , Hantour Usama , Alamoudi Uthman , Jotautas Valdemaras , Parent Valentine , Castillo Vanessa Dina Palomino , Msosa Vanessa , Guglielmo Vania , Silvestri Vania , Despotidis Vasileios , Kalles Vasileios , Soulou Vasiliki , Kalles Vassilis , Shatkar Veereanna , Barendegere Venerand , Grassi Veronica , Lazzari Veronica , Jennings Vicky , Dassah Victor , Etwire Victor , Kong Victor , Riaza Victor Manuel Quintero , Nwinee Victor , Proctor Victoria K , Upadhyaya Vijaid , Gadhvi Vijay , Ambrozeviciute Viktorija , Nevieraite Viktorija , Sallinen Ville , Thanusan Vimalakanthan , Banaitis Vincas Jonas , Beisa Virgilijus , Sollazzo Viviana , Graffieille Vivien , Nsengimana Vizir Jean Paul , Khokha Vladimir , Le Vu Thanh Hien , Gaižauskas Vytautas , Lipnickas Vytautas , Anwer Wahid , Soon Wai Cheong , Lam Wai Him , Ndegwa Wairimu , Thabet Waleed , Adham Walid , Forno Walter , Panez Walter Ruiz , Nasir Wan Nurul ‘Ain Wan Mohd , Senanayake Wanigasekara Senanayake Mudiyanselage Kithsiri Janakantha , Hamsho Ward , Dar Wasim , Alhazmi Wedyan , Guo Wei , Ho Weiguang , Dao Weihei , Aguilar Wendy Leslie Messa , Goh Wennweoi , Jeo Wifanto Saditya , Pino Wilfredo , Appeadu-Mensah William , Beasley William , Bonney William , Hutch William , Lossius William J. , Milligan William , Ticona Willy Alcca , Li Wing Sum , Chachulski Witold , Delforge Xavier , Rodriguez Xianelle , Low Xinwei , Chan Xue Wei , Neo Ya Theng , Souaibou Yacoubou Imorou , Ukwenya Yahaya , Salama Yahya , Rajjoub Yaseen , Ibrahim Yasmein , Abd-Elrasoul Yasmin , Elfouly Yasmin , Hegazy Yasmin , Soliman Yasmin , Salam Yasser Abd El , Tan Yee Wen , Zakaria Yehia , Reddy Yella , Tan Yi Koon , Mok Yi Ting , Cheong Yih Jeng , Gan Yiing Yee , Der Yishan , Mogan Yogendra Praveen , Allam Yomna , Asar Yomna Hosny , Tew Yong Yong , Abuowda Yousef , Shoura Yousra El , Bermúdez Ysabel Esthefany Alejos , Cengiz Yücel , Cheung Yuk Hong Eric , Altinel Yuksel , Ng Yung Kok , Macchitella Yuri , Aigrain Yves , Mikwar Zaher , Jaffry Zahra , Khan Zain Ali , Iftikhar Zainab , Elsayed Zaynab M , Zhang Zhongtao , Sam Zi Hao , Urniežius Zigmantas , Dambrauskas Zilvinas , Bentounsi Zineb , Tverskis Zygimantas 
Published: October 2022

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.