Premature Mortality Costs Research Articles

Social Costs of Smoking in the Czech Republic.

Smoking is an important risk factor leading to many diseases, which brings substantial healthcare costs as well as indirect costs due to decreased productivity. This article aims to quantify the social costs of smoking in the Czech Republic in 2019. The prevalence-based, cost-of-illness approach is used, which assesses the costs as the sum of direct (healthcare) costs and indirect costs (productivity losses due to mortality and morbidity). The costs of healthcare utilization and pharmacotherapy in direct costs, and the costs of absenteeism, presenteeism, and premature mortality in indirect costs, are included. Total costs of smoking in the Czech Republic in 2019 are estimated as 2110.6 million EUR (0.94% of GDP). Direct costs amounted to 537.0 million EUR (2.9% of health expenditures in 2019) and indirect costs were 1573.6 million EUR, mainly driven by the costs of premature mortality (1062.5 million EUR). Despite the declining trend in the prevalence of smoking in the Czech Republic, the associated costs are considerable. Investments into strategies to reduce smoking continue to be needed.

Assessing a decade of leukaemia-related premature mortality costs: impact on productivity loss in Spain.

Cancer mortality is one of the dominant causes of productivity loss; and within all cancer sites, blood cancer is the fourth most common cause of death in Spain. Thus, its impacts in work productivity are a major concern and represent a high social impact. The aim of this study was to evaluate the productivity losses resulting from of premature deaths due to leukaemia in Spain. The productivity costs stemming from premature mortality due to leukaemia were estimated using the human capital method. Information pertaining to mortality rates, typical incomes, and joblessness figures was gathered throughout a decade-long period spanning from 2012 to 2021. Leukaemia caused 40% of haematological malignancies losses. It represented a 3.39% of all cancer-related deaths. In addition, it was responsible for 7,851 years of potential productive life lost (YPLPLL) in 2021, and productivity losses of €4,206.52million over the 10-year period. All these numbers are relevant for Spain as will help on a more efficient distribution of resource. These productivity losses obtained, highlight the burden of leukaemia on the Spanish population, providing novel data on the number of deaths, trends and productivity losses for this type of cancer. This evaluation offers fresh insights that can aid policymakers in efficiently distributing resources, thereby lessening the economic burden it imposes on individuals of working age.

Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study

IntroductionNon-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades....

The indirect costs of vaccine-preventable cancer mortality in the Middle East and North Africa (MENA)

Background Infections are responsible for ∼13% of cancer cases worldwide, with human papillomavirus (HPV) and hepatitis B (HBV) among the infections associated with cancer for which vaccines are available. The aim of this study was to estimate the indirect cost of premature mortality related to cancers caused by HPV and HBV in Middle East and North Africa (MENA) countries. Methods The number of deaths and years of life lost (YLL) in 2019 from four HPV-related cancers: cervical cancer, oral cavity cancer, laryngeal cancer, and oropharynx cancer, as well as HBV-related liver cancer were sourced from the Institute for Health Metrics Evaluation (IHME) Global Burden of Disease database. HPV-attributable fractions were applied to deaths and YLL. The human capital approach was used to measure productivity loss, through value of YLL (VYLL), and estimated using gross domestic product per capita (World Bank; in USD). Seventeen countries in the MENA region were included. Four countries in the region were not included due to data availability. Results In 2019, there were 11,645 potentially vaccine-preventable cancer-related deaths across the MENA region. This resulted in an indirect cost of $1,688,821,605, with 76.1% of this accrued in the Middle East ($1,284,923,633). The number of deaths in the Middle East (5,986) were similar to Northern Africa (5,659) but YLL were higher in Northern Africa (179,425) compared to the Middle East (169,207). The highest indirect cost per death occurred in Qatar ($1,378,991), compared to $14,962 in Sudan. Oral cavity cancer had the highest VYLL per death ($186,084). Conclusions There is a high burden of premature mortality and indirect costs of potentially vaccine-preventable cancer-related deaths in the MENA region. Improved vaccination program implementation, increased vaccine coverage of HPV and HBV vaccinations, and continued prioritization of public health measures, such as screening, could effectively reduce premature mortality and associated costs.

A prospective health economic evaluation to determine the productivity loss due to premature mortality from oral cancer in India.

India contributes two-thirds of the global mortality due to oral cancer and has a younger population at risk. The societal costs of this premature mortality are barely discussed. Using the human capital approach, we aimed to estimate the productivity lost due to premature mortality, valued using individual socioeconomic data, related to oral cancer in India. A bottom-up approach was used to prospectively collect data of 100 consecutive patients with oral cancer treated between 2019 and 2020, with a follow-up of 36 months. The disease-specific survival for early and advanced stage was 85% and 70%, with a median age of 47 years. With 671 years lost prematurely, the loss of productivity was $41 900/early and $96 044/advanced stage. Based on population level rates, the total cost of premature mortality was $5.6 billion, representing 0.18% of GDP. India needs to implement tailored strategies to reduce the economic burden from premature mortality.

Health Economic Consequences Associated With COVID-19–Related Delay in Melanoma Diagnosis in Europe

The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. COVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.

Cost of Illness of Head and Neck Cancer in Sweden

ObjectivesHead and neck cancer (HNC) is the sixth most common cancer worldwide. The condition and its treatment often lead to marked morbidities and, for some patients, premature death. Inferentially, HNC imposes a significant economic burden on society. This study aims to provide a comprehensive and detailed estimation of the cost of illness of HNC for Sweden in 2019. MethodsThis is a prevalence-based cost of illness study. Resource utilization and related costs are quantified using national registry data. A societal perspective is applied, including (1) direct costs for healthcare utilization, (2) costs for informal care from family and friends, and (3) costs for productivity loss due to morbidity and premature death. The human capital approach is used when estimating productivity losses. ResultsThe societal cost of HNC for Sweden in 2019 was estimated at €92 million, of which the direct costs, costs for informal care, and costs for productivity loss represented 34%, 2%, and 64%, respectively. Oral cavity cancer was the costliest HNC, followed by oropharyngeal cancer, whereas nasopharyngeal cancer was the costliest per person. The cost of premature mortality comprised 60% of the total cost of productivity loss. Males accounted for 65% of direct costs and 67% of costs for productivity loss. ConclusionsThe societal cost of HNC is substantial and constitutes a considerable burden to Swedish society. The results of the present study may be used by policymakers for planning and allocation of resources. Furthermore, the information may be used for future cost-effectiveness analyses.

Contrasting clinical outcomes and socio-economic impact of young versus elderly-onset oral squamous cell carcinoma, a novel health economic analysis.

The incidence of young-onset oral squamous cell carcinoma (OSCC) is growing, even among non-smokers/drinkers. The effects of adverse histopathological features on long-term oncologic outcomes between the young and old are controversial and confounded by significant heterogeneity. Few studies have evaluated the socio-economic impact of premature mortality from OSCC. Our study seeks to quantify these differences and their economic impact on society. Four hundred and seventy-eight young (<45 years) and 1660 old patients (≥45 years) with OSCC were studied. Logistic regression determined predictors of recurrence and death. Survival analysis was calculated via the Kaplan-Meier method. A separate health economic analysis was conducted for India and Singapore. Years of Potential Productive Life Lost (YPPLL) were estimated with the Human Capital Approach, and premature mortality cost was derived using population-level data. Adverse histopathological features were seen more frequently in young OSCC: PNI (42.9% vs. 35%, p = 0.002), LVI (22.4% vs. 17.3%, p = 0.013) and ENE (36% vs. 24.5%, p < 0.001). Although 5-year OS/DSS were similar, the young cohort had received more intensive adjuvant therapy (CCRT 26.9% vs. 16.6%, p < 0.001). Among Singaporean males, the premature mortality cost per death was US $396,528, and per YPPLL was US $45,486. This was US $397,402 and US $38,458 for females. Among Indian males, the premature mortality cost per death was US $30,641, and per YPPLL was US $595. This was US $ 21,038 and US $305 for females. Young-onset OSCC is an aggressive disease, mitigated by the ability to receive intensive adjuvant treatment. From our loss of productivity analysis, the socio-economic costs from premature mortality are substantial. Early cancer screening and educational outreach campaigns should be tailored to this cohort. Alongside, more funding should be diverted to genetic research, developing novel biomarkers and improving the efficacy of adjuvant treatment in OSCC.

Prospects for Achieving the Sustainable Development Goals in Ukraine to Reduce Mortality Due to Non-Communicable Diseases: The Impact of the Covid-19 Pandemic and russian Aggression

Today, in Ukraine, as in the world, non-communicable diseases (NCDs) are an urgent problem that goes beyond public health. NCDs determine significant economic and demographic losses as a result of temporary and permanent incapacity for work, a drop in labor productivity, costs of medical care and premature mortality. More than 86% of premature deaths from NCDs occur in low- and middle-income countries, including Ukraine. Reducing premature mortality from non-communicable diseases was chosen as one of the targets of the 2030 Agenda for Sustainable Development under Goal 3 Good health and well-being.&#x0D; A threat to the achievement of this and related targets of the Sustainable Development Goals (SDG) in the world and in Ukraine was the successive combined negative impact of a complex of factors due to the pandemic of the coronavirus disease and the aggression of the Russian Federation.&#x0D; The aim of the work is to assess the dynamics of mortality due to non-communicable diseases by selected causes of death based on the monitoring of national indicators of the achievement of the Sustainable Development Goals in Ukraine within the framework of the targets of Goal 3. Good health and well-being; identify and analyze a complex of factors related to the COVID-19 pandemic and Russia’s aggression that influence these changes; substantiate the assumptions regarding the prospects for the implementation of the targets set by the country in the 2030 Agenda for Sustainable Development in the area of the epidemiological situation regarding non-communicable diseases (in particular, regarding the reduction of mortality from them).&#x0D; The assessment of the pre-war situation and changes during the COVID-19 pandemic for the period 2019–2021 was carried out on the basis of data from the State Statistics Service of Ukraine on mortality from non-communicable diseases, which correspond to selected national indicators and data from the monitoring of indicators of SDG: Ukraine. The Sustainable Development Goals Report 2021, 2022, 2023 and data from the National Cancer Registry of Ukraine were used.&#x0D; Due to complications in obtaining, summarizing and analyzing statistical data on mortality in Ukraine with the beginning of the large-scale invasion of the Russian Federation, assumptions about mortality shifts according to selected national indicators of the implementation of the targets of the 2030 Agenda for Sustainable Development are limited by directions.&#x0D; As of 2021, the COVID-19 pandemic has slowed progress towards achieving the Sustainable Development Agenda in terms of reducing premature mortality from NCDs: according to four of the six national indicators that track progress in this area (3.4.1, 3.4.4, 3.5.1, and 3.5.2) there was a deviation from the planned trajectory and an excess of intermediate results for 2020.&#x0D; The aggression of the Russian Federation in Ukraine threatened to an even greater extent the implementation of measures aimed at achieving the selected indicators. Mortality from NCDs (primarily from cardiovascular diseases) is projected to increase by 2022, as well as in the period before the end of the war and in the immediate period after, with a widening gap between the mortality rates of men and women. In particular, with a high degree of probability, we can expect in the coming years, an increase in morbidity and mortality due cerebrovascular diseases, as well as a "rejuvenation" of the age at which a cerebrovascular disaster occurs.&#x0D; The main factors, the synergistic effect of which has already determined and will determine in the near future an increase in the risk of dying due to non-communicable diseases, including prematurely, are the difficulty of access to the necessary medical services and medicines; decrease in their availability, including economic, with growing dissatisfaction with the needs of people with NCDs in medical care; disruption of the functioning of medical institutions; delay / inability to receive necessary treatment; increasing the influence of the main risk factors and reducing the possibilities of their minimization; the presence of the majority of the population in a state of stress and the prevalence of the practice of overcoming it due to excessive use of alcohol and tobacco; immediate and distant consequences of the transferred coronavirus disease, especially Long COVID; reduced adherence to treatment and lifestyle changes, etc.&#x0D; With every day of the war, the threat of non-fulfillment (incomplete fulfillment) of the tasks set within the framework of Goal 3 to reduce mortality due to NCDs in Ukraine by 2030 deepens. There is a need to review and update national tasks taking into account existing threats and challenges, including in the field of NCDs.

Using Population Segmentation to Identify Opportunities for Integrated Care in Ontario, Canada.

Ontario, Canada has introduced Ontario Health Teams (OHTs) to advance integrated care and population health management. There are currently 54 OHTs covering a population of nearly 14 Million individuals. The teams are expected to plan and implement new care models that improve quadruple aim goals of patient and provider experience, health outcomes and cost efficiency. The Health System Performance Network (HSPN) is funded by the Ontario Ministry of Health to provide evaluation and research to support OHTs. The HSPN is using population segmentation alongside performance measurement to support OHTs to identify populations for improvement. OHTs are using the data provided by HSPN to target opportunities for improvement. This presentation summarizes the performance measures and population segmentation approach used in Ontario to advance integrated care and population health. &#x0D; HSPN is using the British Columbia Health System Matrix (BCHSM), based on the Bridges to Health model to segment the population for each OHT. HSPN has identified 10 overall indicators of performance for OHTs ranging from premature mortality to continuity of physician care. There are also 5 measures respectively in several specific populations including older adults, mental health, and end of life. Indicators are also examined according to socioeconomic strata. This presentation will overview the population segmentation methodology, the ways that performance indicators vary according to population segments, and the ways that OHTs receive the data and are coached in the use of data to target and advance integrated care initiatives. &#x0D; The BCHSM provides 14 different population segments ranging from non-users to low-users to frail older adults in the community to people at the end of life. Increasing frailty and clinical complexity is strongly related to the population segments/groups and premature mortality and total system costs correspond as well to increasing patient complexity. The BCHSM has high face-validity. Improvement indicators for mental health and health system priorities such as emergency presentations for mental health reasons and delayed discharge from acute hospital are also more common in specific population groups which helps to prioritize and target interventions. These data are supporting the development of specific integrated care programs to address health needs in underserved populations.

Economic costs of alcohol consumption in Thailand, 2021

BackgroundAlcohol is one of the leading risk factors contributing to avoidable economic loss worldwide. Estimates from the economic cost of alcohol consumption studies play an important role in prioritizing healthcare resource use, supporting policy decisions, and justifying budgets for alcohol policy. This study aimed to estimate the economic burden associated with alcohol consumption in Thailand in 2021.MethodsPrevalence-based cost of illness methodology was employed. The following costs were included in the analysis: healthcare costs; cost of law enforcement; cost of property damage due to road traffic accidents; cost of premature mortality; and cost of absenteeism from out-patient hospital visits and hospitalization. Human capital approach was adopted. All costs were presented in Thai baht, 2021.ResultsAlcohol consumption incurred a total estimated economic cost of 165,450.5 million baht, equivalent to 1.02% of Gross Domestic Product (GDP) and 2500 baht per capita. Cost of premature mortality was estimated at 157,918.7 million baht and accounted for the largest proportion of the total cost (95.45%). Healthcare cost was found to be the second highest share representing 4370.1 million baht (2.7% of the total cost). The number of premature death attributable to alcohol consumption in 2021 was estimated at 22,804.ConclusionsAlcohol continues to impose a substantial economic burden in Thailand. Enforcement of existing well-formulated alcohol control policies is urgently required to mitigate the economic impact of alcohol consumption in the country.

Five Years of Accurate PM2.5 Measurements Demonstrate the Value of Low-Cost PurpleAir Monitors in Areas Affected by Woodsmoke

Low-cost optical sensors are used in many countries to monitor fine particulate (PM2.5) air pollution, especially in cities and towns with large spatial and temporal variation due to woodsmoke pollution. Previous peer-reviewed research derived calibration equations for PurpleAir (PA) sensors by co-locating PA units at a government regulatory air pollution monitoring site in Armidale, NSW, Australia, a town where woodsmoke is the main source of PM2.5 pollution. The calibrations enabled the PA sensors to provide accurate estimates of PM2.5 that were almost identical to those from the NSW Government reference equipment and allowed the high levels of wintertime PM2.5 pollution and the substantial spatial and temporal variation from wood heaters to be quantified, as well as the estimated costs of premature mortality exceeding $10,000 per wood heater per year. This follow-up study evaluates eight PA sensors co-located at the same government site to check their accuracy over the following four years, using either the original calibrations, the default woodsmoke equation on the PA website for uncalibrated sensors, or the ALT-34 conversion equation (see text). Minimal calibration drift was observed, with year-round correlations, r = 0.98 ± 0.01, and root mean square error (RMSE) = 2.0 μg/m3 for daily average PA PM2.5 vs. reference equipment. The utitilty of the PA sensors without prior calibration at locations affected by woodsmoke was also demonstrated by the year-round correlations of 0.94 and low RMSE between PA (woodsmoke and ALT-34 conversions) and reference PM2.5 at the NSW Government monitoring sites in Orange and Gunnedah. To ensure the reliability of the PA data, basic quality checks are recommended, including the agreement of the two laser sensors in each PA unit and removing any transient spikes affecting only one sensor. In Armidale, from 2019 to 2022, the continuing high spatial variation in the PM2.5 levels observed during the colder months was many times higher than any discrepancies between the PA and reference measurements. Particularly unhealthy PM2.5 levels were noted in southern and eastern central Armidale. The measurements inside two older weatherboard houses in Armidale showed that high outdoor pollution resulted in high pollution inside the houses within 1–2 h. Daily average PM2.5 concentrations available on the PA website allow air pollution at different sites across regions (and countries) to be compared. Such comparisons revealed major elevations in PA PM2.5 at Gunnedah, Orange, Monash (Australian Capital Territory), and Christchurch (New Zealand) during the wood heating season. The data for Gunnedah and Muswellbrook suggest a slight underestimation of PM2.5 at other times of the year when there are proportionately more dust and other larger particles. A network of appropriately calibrated PA sensors can provide valuable information on the spatial and temporal variation in the air pollution that can be used to identify pollution hotspots, improve estimates of population exposure and health costs, and inform public policy.

The economic costs of COVID‐19 in a rural Western US state

AbstractThe impact of the coronavirus disease‐2019 (COVID‐19) pandemic has been felt worldwide. While the United States appears to be on path to recovery, the economic burden and rising medical care expenditures associated with the pandemic remains in the trillions of dollars. Utilizing data from the US Department of Health and Human Services and FAIR Health, this study estimates the economic burden of COVID‐19 for Idaho was estimated through assessment of direct medical costs and indirect costs for years 2020–2021. Total direct medical hospital costs associated with COVID‐19, among adults, were estimated as the sum of hospital costs associated with inpatient visits. The cost of testing was included in the direct cost assessment, with data from the Idaho Division of Public Health and Medicare Administrative Contractor payment rates. To determine indirect absenteeism costs, daily cases were multiplied by 7 to account for days of missed productivity; this number was then multiplied by an employment‐adjusted average daily wage to obtain a lost productivity dollar value. Lastly, premature mortality costs were estimated based on the lost value of future earnings. Results show that in 2020, the associated direct and indirect costs of COVID‐19 amounted to over $608 million and increased to over $1.3 billion in 2021 for the state of Idaho. As the pandemic lingers on with new variants and mutations, rising costs will continue to place a heavy burden on many Idahoans, who are already often face disparate health outcomes and access to health care.

Long-term multimorbidity trajectories in older adults: The role of cancer, demographics, and health behaviors.

Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. In 82,754 participants (mean age, 71.6 years [SD,5.1 years]; 56.9% female), cancer survivors (n=11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR],1.36; 95% CI, 1.29-1.45), and (2) high scores that increased over time (start high and increase; OR,1.51; 95% CI, 1.38-1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR,0.73; 95% CI, 0.64-0.84, remain high; OR,0.42; 95% CI, 0.33-0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR,2.83; 95% CI, 2.32-3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR,6.86; 95% CI, 4.41-10.66 vs. never smokers). Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.

Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis

Lead exposure is a worldwide health risk despite substantial declines in blood lead levels following the leaded gasoline phase-out. For the first time, to our knowledge, we aimed to estimate the global burden and cost of intelligence quotient (IQ) loss and cardiovascular disease mortality from lead exposure. In this modelling study, we used country blood lead level estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We estimated IQ loss (presented as estimated loss in IQ points with 95% CIs) in the global population of children younger than 5 years using the blood lead level-IQ loss function from an international pooled analysis. We estimated the cost of IQ loss, which was calculated only for the proportion of children expected to enter the labour force, as the present value of loss in lifetime income from the IQ loss (presented as cost in US dollars and percentage of gross domestic product with a range). We estimated cardiovascular deaths (with 95% CIs) due to lead exposure among people aged 25 years or older using a health impact model that captures the effect of lead exposure on cardiovascular disease mortality that is mediated through mechanisms other than hypertension. Finally, we used values of statistical life to estimate the welfare cost of premature mortality (presented as cost in US dollars and percentage of GDP). All estimates were calculated by World Bank income classification and region (for low-income and middle-income countries [LMICs] only) for 2019. We estimated that children younger than 5 years lost 765 million (95% CI 443-1098) IQ points and that 5 545 000 (2 305 000-8 271 000) adults died from cardiovascular disease in 2019 due to lead exposure. 729 million of the IQ points lost (95·3% of the total global IQ loss) and 5 004 000 (90·2% of total) cardiovascular disease deaths due to lead exposure occurred in LMICs. IQ loss in LMICs was nearly 80% higher than a previous estimate. Cardiovascular disease deaths were six times higher than the GBD 2019 estimate. The global cost of lead exposure was US$6·0 trillion (range 2·6-9·0) in 2019, which was equivalent to 6·9% (3·1-10·4) of the global gross domestic product. 77% (range 70-78) of the cost was the welfare cost of cardiovascular disease mortality, and 23% (22-30) was the present value of future income losses from IQ loss. Our findings suggest that global lead exposure has health and economic costs at par with PM2·5 air pollution. However, much work remains to improve the quality of blood lead level measurement data, especially in LMICs. The Korea Green Growth Trust Fund and the World Bank's Pollution Management and Environmental Health Program.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Indirect (Individual and Societal) and Direct Out-of-Pocket Costs.

People living with inflammatory bowel disease (IBD) and their caregivers are faced with indirect and out-of-pocket costs that they would not otherwise experience. These costs impact one's ability to contribute to the economy to their fullest potential. The indirect costs of IBD in Canada are estimated to be at least $1.51 billion in 2023 and include costs associated with lost productivity resulting from a combination of missed work (absenteeism), decreased workplace productivity (presenteeism), unemployment, premature mortality, and caregiving costs. Unemployment is the largest contributor to indirect costs ($1.14 billion), followed by costs of absenteeism and presenteeism ($285 million). Caregiving costs for children with IBD are estimated to be nearly $58 million. Canadians with IBD also pay $536 million every year for care that is not covered by universal or supplemental private health insurance; this includes allied healthcare (e.g., care provided by psychologists), medication, and other supportive therapy. Combined, the indirect and out-of-pocket costs of IBD in Canada are estimated at more than $2 billion CAD in 2023. This is substantially higher than the estimate of $1.29 billion in Crohn's and Colitis Canada's 2018 Impact of IBD report with differences attributable to a combination of rising prevalence, inflation, and the addition of presenteeism and caregiving costs to the total indirect costs.

Economic burden of cancer attributable to modifiable risk factors in Japan.

Controlling avoidable causes of cancer may save cancer-related healthcare costs and indirect costs of premature deaths and productivity loss. This study aimed to estimate the economic burden of cancer attributable to major lifestyle and environmental risk factors in Japan in 2015. We evaluated the economic cost of cancer attributable to modifiable risk factors from a societal perspective. We obtained the direct medical costs for 2015 from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, and estimated the indirect costs of premature mortality and of morbidity due to cancer using the relevant national surveys in Japan. Finally, we estimated the economic cost of cancer associated with lifestyle and environmental risk factors. The estimated cost of cancer attributable to lifestyle and environmental factors was 1,024,006 million Japanese yen (¥) (8,460 million US dollars [$]) for both sexes, and ¥673,780 million ($5,566 million) in men and ¥350,226 million ($2,893 million) in women, using the average exchange rate in 2015 ($1 = ¥121.044). A total of ¥285,150 million ($2,356 million) was lost due to premature death in Japan in 2015. Indirect morbidity costs that could have been prevented were estimated to be ¥200,602 million ($1,657 million). Productivity loss was highest for stomach cancer in men (¥28,735 million/$237 million) and cervical cancer in women (¥24,448 million/$202 million). Preventing and controlling cancers caused by infections including Helicobacter pylori, human papillomavirus and tobacco smoking will not only be life-saving but may also be cost-saving in the long run.

The Cost of Foodborne Illness and Its Sequelae in Australia Circa 2019.

Foodborne illnesses cause a significant health burden, with Campylobacter and norovirus the most common causes of illness and Salmonella a common cause of hospitalization and occasional cause of death. Estimating the cost of illness can assist in quantifying this health burden, with pathogen-specific costs informing prioritization of interventions. We used a simulation-based approach to cost foodborne disease in Australia, capturing the cost of premature mortality, direct costs of nonfatal illness (including health care costs, medications, and tests), indirect costs of illness due to lost productivity, and costs associated with pain and suffering. In Australia circa 2019, the cost in Australian Dollars (AUD) of foodborne illness and its sequelae was 2.44 billion (90% uncertainty interval 1.65-3.68) each year, with the highest pathogen-specific costs for Campylobacter, non-typhoidal Salmonella, non-Shiga toxin-producing pathogenic Escherichia coli, and norovirus. The highest cost per case was for Listeria monocytogenes (AUD 776,000). Lost productivity was the largest component cost for foodborne illness due to all causes and for most individual pathogens; the exceptions were pathogens causing more severe illness such as Salmonella and L. monocytogenes, where premature mortality was the largest component cost. Foodborne illness results in a substantial cost to Australia; interventions to improve food safety across industry, retail, and consumers are needed to maintain public health safety.

Projected Impact on Labour Productivity Costs of Cancer-Related Premature Mortality in Europe 2018-2040.

To estimate the potential cost of lost labour productivity due to cancer-related premature mortality in Europe (EU-27 plus Norway, Switzerland, Iceland and United Kingdom) from 2018 to 2040. Deaths and years of potential productive life lost due to 23 types of cancer were estimated for 2018-2040, for 31 European countries. The data were analysed by age groups, by sex and by year. Projected productivity costs were estimated by calculating gross earnings by country, gender and age group using the Human Capital Approach, adjusting for projected labour force participation and unemployment rates. Various data sources were used. Sensitivity analyses were conducted. Between 2018 and 2040, cancer is expected to cause around eight million premature deaths (58% male). The cumulative projected productivity costs in this respect are €1.3 trillion, representing an annual average of €58.7 billion, or 0.43% of the EU-27 gross domestic product. Labour productivity costs are projected to decrease by 6% from 2018 to 2040. The highest cost region is Western Europe, where Germany and France will experience the highest cumulative losses (€288 and €192 billion, respectively). The most costly cancers, in terms of total costs related to productivity losses, are of the lung and colorectum (€264.4 and €116.3 billion, respectively). In terms of average productivity cost per death, the most costly forms of cancer are Hodgkin lymphoma (€301,157) and melanoma (€260,522). The novel information presented could help national policymakers anticipate possible areas for cost savings. Action should be taken on disease prevention, on reducing mortality and on delaying the age of death due to Hodgkin lymphoma, brain cancer, leukaemia and melanoma. Furthermore, the study findings enhance our understanding of macroeconomic variables and could be useful in determining a re-allocation of health expenditures.

EE17 Societal Cost of Racial Disparities in Pneumococcal Disease in U.S. Adults Aged 50 Years or Older

Racial health disparities in pneumococcal disease (PD) exist, with greater disease risk and lower vaccination rates in U.S. Black adults. Disparities affect both PD direct costs and longer-term costs of disability and premature mortality. Estimating societal costs of pneumococcal disease disparities in Black adults could inform mitigation of those disparities.