King's Centre for Global Health and Health Partnerships, King's College London and King's Health Partners, Weston Education Centre, London, UK.
Colorectal Surgery, Medway NHS Foundation Trust, Gillingham, United Kingdom.
BMJ Open. 2018 Mar 14;8(3):e017824. doi: 10.1136/bmjopen-2017-017824.
The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist. We aimed to estimate the costs to the Sierra Leone economy from death and disability which may have been averted by surgical care.
We used estimates of total, met and unmet need from two main sources-a cluster randomised, cross-sectional, countrywide survey and a retrospective, nationwide study on surgery in Sierra Leone. We calculated estimated disability-adjusted life years from morbidity and mortality for the estimated unmet burden and modelled the likely economic impact using three different methods-gross national income per capita, lifetime earnings foregone and value of a statistical life.
In 2012, estimated, discounted lifetime losses to the Sierra Leone economy from the unmet burden of surgical disease was between US$1.1 and US$3.8 billion, depending on the economic method used. These lifetime losses equate to between 23% and 100% of the annual GDP for Sierra Leone. 80% of economic losses were due to mortality. The incremental losses averted by scale up of surgical provision to the Lancet Commission target of 80% were calculated to be between US$360 million and US$2.9 billion.
There is a large economic loss from the unmet need for surgical care in Sierra Leone. There is an immediate need for massive investment to counteract ongoing economic losses.
柳叶刀全球手术委员会估计，由于手术疾病未满足的负担，低收入和中等收入国家将累计损失国内生产总值（GDP）约 12.3 万亿美元。然而，目前尚无特定于国家的数据。我们旨在估计塞拉利昂经济因手术护理而避免的死亡和残疾所造成的损失。
我们使用了两个主要来源的总需求、满足需求和未满足需求的估计值-一项集群随机、横断面、全国性调查和塞拉利昂手术的回顾性全国性研究。我们根据发病率和死亡率计算了未满足需求的估计伤残调整生命年，并使用三种不同方法-人均国民总收入、丧失的终身收入和生命价值来模拟可能的经济影响。
2012 年，塞拉利昂经济因手术疾病未满足的负担而造成的预计终身损失，按经济方法计算，在 11 亿美元至 38 亿美元之间。这些终身损失相当于塞拉利昂年 GDP 的 23%至 100%。80%的经济损失归因于死亡率。按柳叶刀委员会目标将手术供应扩大到 80%，预计可避免的增量损失在 3.6 亿美元至 29 亿美元之间。
塞拉利昂的手术护理未满足需求造成了巨大的经济损失。急需进行大规模投资以抵消持续的经济损失。
