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.

中文翻译：

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阑尾炎手术需求未得到满足的全球经济负担

摘要 背景许多低收入和中等收入国家在提供足够的外科护理方面存在巨大差距。本研究旨在确定阑尾炎常见病症未满足的手术需求所造成的经济负担。 方法使用来自 170 个国家的阑尾炎发病率数据和两种不同的方法来估计未接受手术的患者数量： 作为每个国家未满足手术需求总额的固定比例（方法 1）；并基于国家收入状况（方法 2）。估算了当前接入水平和当地质量以及质量达到高收入国家标准的间接成本。采用人力资本方法，重点关注过早死亡和缺勤造成的经济负担。 结果使用方法 1 时，超额死亡率为每 10 万例阑尾炎病例 4185 例，使用方法 2 时，超额死亡率为每 10 万例阑尾炎病例 3448 例。使用方法 1 时，维持当前的获取和当地质量水平的经济负担为 924.92 亿美元，使用方法 2 时为 731.41 亿美元。如果按照方法 1 提供不符合高收入国家标准的手术护理，其经济负担为 950.04 亿美元，如果使用方法 2，则为 756.66 亿美元。这些费用中最大的一部分是过早死亡（97.7%）和缺乏获得机会造成的(97.0%) 与缺乏质量形成鲜明对比。 结论对于阑尾炎等相对不复杂的紧急情况，应优先考虑增加获得护理的机会。尽管提高护理质量不容忽视，但按照当前标准增加护理服务可以大幅降低社会成本。