Economic impact of urinary incontinence and pelvic organ prolapse in women in Belize

Jacqueline Zillioux, MDa, Clinton Yeaman, MDa, Raj Desai, MSb, Devang Sharma, MDa,d, Rajesh Balkrishnan, PhDb, David Rapp, MDa,c,*




Global burden of surgical disease

In 2015, the Lancet Commission on Global Surgery (LCGS) estimated that five billion people lack access to safe and affordable surgical care[1]. As surgical disease is estimated to comprise up to one third of the global burden of disease, this lack of surgical access results in an estimated 17 million annual deaths, notable life years of life lost and life lived with disability, and a significant reduction of quality of life (QOL)[2,3]. In an effort to promote surgical infrastructure development across low and middle income countries (LMIC), the LCGS identified core indicators of surgical care access including specialist work force density and surgical volume metrics[1]. Notably, the LCGS core indicators included the risk of catastrophic expenditure from surgical care[4].

Economic impact of surgical disease

This focus on the economic impact of surgical disease is important. On a macroeconomic level, the LCGS estimated that LMIC economies will lose an estimated $12.3 trillion USD related to unmet surgical disease over 15 years[1,5]. Similarly, Alkire and colleagues estimated that surgical disease may result in GDP losses of up to 2.5% through 2030 using value of lost output modeling across numerous LMICs[6].

In contrast to macroeconomic estimates, little is known regarding the microeconomic impacts of surgical disease to individuals or households. These microeconomic impacts not only occur through direct costs of healthcare expenses, but also indirectly through primary (inability to work, loss of productivity) and secondary mechanisms (inability of the caretaker to work). Available research demonstrates a significant deleterious economic impact to individuals related to untreated surgical disease through loss of work ability or medical expenditures[7,8]. Indeed, although focus on preventing the profound morbidity, mortality, and disability associated with untreated surgical disease is paramount, prevention of financial devastation associated with surgical disease is equally important[2,3].

Urogynecologic disease in LMICs

At the same time, surgical urogynecologic disease (UD) is highly prevalent in LMIC[9]. The significant clinical and social impacts of pelvic floor disorders such as urinary incontinence (UI) and pelvic organ prolapse (POP) are well described and associated with significant deterioration in QOL, depression, and social isolation[10,11]. More recently, focus has also been placed on the vast economic cost of UI[12]. Despite this, there is limited research to understand the microeconomic impact of UI and POP to individuals or households in LMIC. This data is critical as surgical care is generally an extremely cost-effective intervention and paramount as we seek to optimize cost-effective approaches to treat surgical disease[13–15]. We conducted a survey assessment in Belize to understand the impact of urologic disease on work and caretaking responsibilities and to quantify the microeconomic impact to affected individuals.


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