The economic consequences of neurosurgical disease in low- and middle-income countries

Abstract

OBJECTIVE The objective of this study was to estimate the economic consequences of neurosurgical disease in low- and middle-income countries (LMICs). METHODS The authors estimated gross domestic product (GDP) losses and the broader welfare losses attributable to 5 neurosurgical disease categories in LMICs using two distinct economic models. The value of lost output (VLO) model projects annual GDP losses due to neurosurgical disease during 2015-2030, and is based on the WHO's "Projecting the Economic Cost of Ill-health" tool. The value of lost economic welfare (VLW) model estimates total welfare losses, which is based on the value of a statistical life and includes nonmarket losses such as the inherent value placed on good health, resulting from neurosurgical disease in 2015 alone. RESULTS The VLO model estimates the selected neurosurgical diseases will result in $4.4 trillion (2013 US dollars, purchasing power parity) in GDP losses during 2015-2030 in the 90 included LMICs. Economic losses are projected to disproportionately affect low- and lower-middle-income countries, risking up to a 0.6% and 0.54% loss of GDP, respectively, in 2030. The VLW model evaluated 127 LMICs, and estimates that these countries experienced $3 trillion (2013 US dollars, purchasing power parity) in economic welfare losses in 2015. Regardless of the model used, the majority of the losses can be attributed to stroke and traumatic brain injury. CONCLUSIONS The economic impact of neurosurgical diseases in LMICs is significant. The magnitude of economic losses due to neurosurgical diseases in LMICs provides further motivation beyond already compelling humanitarian reasons for action.

Global macroeconomic burden of epilepsy and the role for neurosurgery: a modelling study based upon the 2016 Global Burden of Disease data

“…[33] A number of studies have utilised similar methodology to estimate the economic value of lost welfare associated with various diseases. [24,[34][35][36] respectively. Although, the differing sample populations, years of analysis and incorporated assumptions preclude direct comparison between our results, it is reassuring that they do not appear grossly disproportionate to those reported in this study.…”

“…Similarly, although there will likely be some debate regarding the estimates of disease burden mandating neurosurgical consultation and intervention, in the absence of more compelling information from a range of settings, we thought it reasonable to derive these proportions from a geographically and socio-economically representative sample of neurosurgeons, [21] which is consistent with previous similar studies. [24,[34][35][36] We also acknowledge that the application of a uniform proportion of surgical burden to all countries is likely to be simplistic. Indeed, given that focal epilepsy appears to be more prevalent in LICs and LMICs, it is possible that epilepsy surgery has a greater role in these settings than it does in more developed countries, although this proposal remains conjectural and any attempt to account for it in this analysis would be speculative.…”

Editorial. Research in global neurosurgery: informing the path to achieving neurosurgical equity

“…2 Last, Rudolfson et al showed that, just in the 90 LMICs, neurosurgical conditions, largely unmet at present, will result in $4.4 trillion in cumulative gross domestic product losses by 2030. 8 Taken collectively, there is a compelling moral, ethical, and economical argument for the neurosurgical community to work alongside the global surgery community and development partners to advocate for strengthening emergency and essential surgical care in the LMICs. Future research in global neurosurgery is urgently needed as neurosurgeons are increasingly being asked to provide technical and strategic guidance to policymakers in building capacity to meet the global neurosurgical workforce and case deficit.…”

Editorial. Global neurosurgery and our social responsibility

“…I n this issue of the Journal, I am pleased to highlight and promote the publication of 9 new articles on the topic of global neurosurgery. [4][5][6][7][8][9][10]12,13 Many of the articles in this issue are derived from the efforts of authors from the Global Neurosurgery Initiative and the Program in Global Surgery and Social Change at Harvard and their numerous collaborators. These articles follow on the heels of a recent issue in Neurosurgical Focus (Volume 45: Issue 4, October, 2018) that was entirely devoted to reducing inequities in global neurosurgery delivery.…”