Tuberculosis in a weak health system, conflict and fragile zone: The monetary value of human lives lost associated with deaths of persons older than 14 years in Somalia.

Background: Low tuberculosis (TB) detection and conflict and fragility have overburdened Somalia. This study estimated economic loss associated with TB deaths among persons aged >14 years. Method: Using epidemiologic and economic data, we calculated the cost based on the framework of the World Health Organization guide of identifying the economic consequences of disease and injury. Baseline loss is the product of years of life lost, non‐health expenditure, and number of deaths. Adjusting for conflict and fragility conditions and growth of non‐health expenditure, we discounted the loss at 3% rate. We conducted a sensitivity analysis of epidemiologic and economic factors. Results: In 2017 values, the 9180 reported deaths result in a loss of US$ 44.77 million, a US$ 4877 per death over the discounted years. Conflict conditions would increase the loss by 5.3%, while simultaneous adjustment for conflict and attunement to growth of non‐health expenditure would increase the burden by 54% to US$ 67.28 million. Male fatalities account for 59% of the burden. The baseline result is robust to input variations, although sensitivity analysis suggests conflict and fragility conditions account for greater uncertainty of the loss. Conclusion: Stakeholders in the healthcare system should minimise the sizeable economic loss by taking measures to enhance surveillance of TB and security. Highlights: Recognising Somalia's high TB prevalence but low case detection, we estimated economic loss associated with deaths of persons aged >14 years.Adjusting for conflict and fragility conditions, we used World Health Organization (WHO) guide of identifying the economic consequences of disease and injury.Results suggest sizeable economic loss in Somalia associated with TB deaths exacerbated by conflict and fragility conditions.The results can inform stakeholders to focus on minimising TB‐related economic loss by enhancing surveillance and minimising conflict and insecurity. [ABSTRACT FROM AUTHOR]