Estimates Of Direct Costs Research Articles

The Estimated Direct Medical Cost of Selected Sexually Transmitted Infections in the United States, 2008

Millions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the United States. We assembled recent (i.e., 2002-2011) cost estimates to determine the lifetime cost per case of 8 major STIs (chlamydia, gonorrhea, hepatitis B virus, human immunodeficiency virus (HIV), human papillomavirus, genital herpes simplex virus type 2, trichomoniasis and syphilis). The total direct cost for each STI was computed as the product of the number of new or newly diagnosed cases in 2008 and the estimated discounted lifetime cost per case. All costs were adjusted to 2010 US dollars. Results indicated that the total lifetime direct medical cost of the 19.7 million cases of STIs that occurred among persons of all ages in 2008 in the United States was $15.6 (range, $11.0-$20.6) billion. Total costs were as follows: chlamydia ($516.7 [$258.3-$775.0] million), gonorrhea ($162.1 [$81.1-$243.2] million), hepatitis B virus ($50.7 [$41.3-$55.6] million), HIV ($12.6 [$9.5-$15.7] billion), human papillomavirus ($1.7 [$0.8-$2.9] billion), herpes simplex virus type 2 ($540.7 [$270.3-$811.0] million), syphilis ($39.3 [$19.6-$58.9] million), and trichomoniasis ($24.0 [$12.0-$36.0] million). Costs associated with HIV infection accounted for more than 81% of the total cost. Among the nonviral STIs, chlamydia was the most costly infection. Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States. The burden of STIs would be even greater in the absence of STI prevention and control efforts.

Estimation of direct and indirect cost of diabetes in Morocco

Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, studies have shown that the cost of diabetes per person is much higher than the per capita health expenditure. This study is the first to estimate the direct and indirect cost of diabetes in Morocco. The direct cost of diabetes was computed by assuming three scenarios of prices (low, medium and high) due to different prices of insulin, oral drugs and other items used in diabetes treatment and care. Indirect costs of diabetes were estimated by the lifetime forgone earnings caused by premature death and disability due to diabetes. The direct cost of diabetes in Morocco was estimated to be between US $0.47 and US $1.5 billion whereas the indirect cost was estimated to be around US $2 billion accounting for 57% of the total cost of diabetes under the high cost scenario, 69% under the medium scenario and 81% under the low cost scenario. The average per capita indirect cost was estimated to be US $1113, relatively higher than the direct cost of diabetes which was seen to vary from US$ 259 to US $830. The results yielded by this study were compared to those obtained by similar studies in different regions and countries of the world. As a conclusion, the findings of this study indicate a high economic burden of diabetes and stress the importance that Moroccan health decision makers should give to sensitisation, early diagnosis and treatment of diabetes especially with the crucial growing trend of diabetes prevalence.

Inconsistencies in Nice Guidance for Acupuncture: Reanalysis and Discussion

Acupuncture received a positive recommendation in the National Institute for Health and Clinical Excellence (NICE) clinical guideline for low back pain (LBP). However, no such recommendation was forthcoming in the NICE clinical guideline for osteoarthritis (OA). Importantly, the two guidelines adopted different treatment comparators in their economic analyses of acupuncture; in the LBP guideline 'usual care' was used (with no consideration of placebo/sham interventions), whereas 'sham acupuncture' was the comparator in the OA guideline. To analyse the implications of using different control group comparators when estimating the cost-effectiveness of acupuncture therapy. The NICE OA economic analysis for acupuncture was replicated using 'usual care' (ie, no placebo/sham component) as the treatment comparator. A 'transfer-to-utility' technique was used to transform Western Ontario and McMaster Osteoarthritis scores into EQ-5D utility scores to allow quality-adjusted life year (QALY) gains to be estimated. QALY estimates were combined with direct incremental cost estimates of acupuncture treatment to determine incremental cost-effectiveness ratios (ICERs). When 'usual care' was used as the treatment comparator, ICER point estimates were below £20 000 per QALY gained for each acupuncture trial analysed in the OA clinical guideline. In the original analysis, using placebo/sham acupuncture as the treatment comparator, ICERs were generally above £20 000 per QALY gained. The treatment comparator chosen in economic evaluations of acupuncture therapy is likely to be a strong determinant of the cost-effectiveness results. Different comparators used in the OA and LBP NICE guidelines may have led to the divergent recommendations in the guidelines.

Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States

Estimates of the direct medical costs attributable to human papillomavirus (HPV) can help to quantify the economic burden of HPV and to illustrate the potential benefits of HPV vaccination. The purpose of this report was to update the estimated annual direct medical costs of the prevention and treatment of HPV-associated disease in the United States, for all HPV types. We included the costs of cervical cancer screening and follow-up and the treatment costs of the following HPV-associated health outcomes: cervical cancer, other anogenital cancers (anal, vaginal, vulvar and penile), oropharyngeal cancer, genital warts, and recurrent respiratory papillomatosis (RRP). We obtained updated incidence and cost estimates from the literature. The overall annual direct medical cost burden of preventing and treating HPV-associated disease was estimated to be $8.0 billion (2010 U.S. dollars). Of this total cost, about $6.6 billion (82.3%) was for routine cervical cancer screening and follow-up, $1.0 billion (12.0%) was for cancer (including $0.4 billion for cervical cancer and $0.3 billion for oropharyngeal cancer), $0.3 billion (3.6%) was for genital warts, and $0.2 billion (2.1%) was for RRP.

Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss

The care of patients with critical limb ischemia (CLI) and tissue loss is notoriously challenging and expensive. We evaluated the cost-effectiveness of various management strategies to identify those that would optimize value to patients. A probabilistic Markov model was used to create a detailed simulation of patient-oriented outcomes, including clinical events, wound healing, functional outcomes, and quality-adjusted life-years (QALYs) after various management strategies in a CLI patient cohort during a 10-year period. Direct and indirect cost estimates for these strategies were obtained using transition cost-accounting methodology. Incremental cost-effectiveness ratios (ICERs), in 2009 U.S. dollars per QALYs, were calculated compared with the most conservative management strategy of local wound care with amputation as needed. With an ICER of $47,735/QALY, an initial surgical bypass with subsequent endovascular revision(s) as needed was the most cost-effective alternative to local wound care alone. Endovascular-first management strategies achieved comparable clinical outcomes but at higher cost (ICERs ≥$101,702/QALY); however, endovascular management did become cost-effective when the initial foot wound closure rate was >37% or when procedural costs were decreased by >42%. Primary amputation was dominated (less effectiveness and more costly than wound care alone). Contemporary clinical effectiveness and cost estimates show an initial surgical bypass is the most cost-effective alternative to local wound care alone for CLI with tissue loss and can be supported even in a cost-averse health care environment.

Direct Costs of Cervical Cancer Management in Morocco

For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a late stage (stage II or more). The cost of one case of cervical cancer depends on stage of diagnosis, the lowest cost is $382 for stage Cis followed by the cost of stage IA1 for young women (<40 years) which is $2,952. The highest cost is for stage IV, which is $7,827. The total cost of cervical cancer care for one year after diagnosis is estimated at $13,589,360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13,027,609 whereas other cost components are represented as follows: $435,694 for annual follow-up activity and $126,057 for diagnosis and preclinical staging. This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco.

Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings

BackgroundA major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. ObjectiveThis study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. DesignWe conducted a 1-year prospective randomized controlled clinical trial. Participants/settingThe study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. InterventionThe intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main outcome measuresProgram delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical analyses performedNonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. ResultsMedian weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control). ConclusionsBoth the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.

Cost-Effectiveness of Expanded Newborn Screening in Texas

ObjectiveTexas House Bill 790 resulted in the expansion of the newborn screening panel from 7 disorders to 27 disorders. Implementation of this change began in 2007. The objective of this study was to estimate the incremental cost-effectiveness of the expanded newborn screening program compared with the previous standard screening in Texas. MethodsA Markov model (for a hypothetical cohort of Texas births in 2007) was constructed to compare lifetime costs and quality-adjusted life-years (QALYs) between the expanded newborn screening and preexpansion newborn screening. Estimates of costs, probabilities of sequelae, and utilities for disorder categories were obtained from a combination of Texas statistics, the literature, and expert opinion. A baseline discount rate of 3% was used for both costs and QALYs, with a range of 0% to 5%. Analyses were conducted from a payer's perspective, and so only direct medical cost estimates were included. ResultsThe lifetime incremental cost-effectiveness ratio for expanded versus preexpansion screening was about $11,560 per QALY. The results remained robust to both deterministic and probabilistic sensitivity analyses. ConclusionsExpanded newborn screening does result in additional expenses to the payer, but it also improves patient outcomes by preventing avoidable morbidity and mortality. The screened population benefits from greater QALYs as compared with the unscreened population. Overall, expanded newborn screening in Texas was estimated to be a cost-effective option as compared with unexpanded newborn screening.

PMH29 Estimates of Schizophrenia-Related Direct Medical Costs Using Attributable and Incremental Cost Approaches

PMH29 Estimates of Schizophrenia-Related Direct Medical Costs Using Attributable and Incremental Cost Approaches

Variation in costs of cone beam CT examinations among healthcare systems

To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

Cost-Effectiveness of a Workplace-Based Incentivized Weight Loss Program

To evaluate the cost-effectiveness ratios of a nursing home-based incentivized Behavioral Weight Management Program (BWMP) from the employer's perspective. Seventy-two overweight and obese health care workers completed the BWMP (n = 35 incentivized; n = 37 nonincentivized). Weight change outcomes were compared for the pre- (0) and postintervention (28 weeks) follow-up periods within and between sites. Comprehensive estimates of BWMP direct program costs and avoided costs of absenteeism and productivity improvements were estimated to evaluate a business case. There was a significant difference (P = 0.01) between the average per-participant weight change between incentivized sites (-7.4 lb) and nonincentivized sites (-2.2 lb). The cost-effectiveness ratios per pound of weight loss were $25.5 and $58.1, respectively. In general, incentivized BWMPs were more cost effective. To generate a business case, enhancement in productivity becomes a critical factor and future research needs to investigate it further.

Estimation of indirect cost and evaluation of protective measures for infrastructure vulnerability: A case study on the transalpine transport corridor

Infrastructure vulnerability is a topic of rising interest in the scientific literature for both the general increase of unexpected events and the strategic importance of certain links. Protective investments are extremely costly and risks are distributed in space and time, which poses important decision problems to the public sector decision makers.In an economic prospective, the evaluation of infrastructure vulnerability is oriented on the estimation of direct and indirect costs of hazards. Although the estimation of direct costs is straightforward, the evaluation of indirect cost involves factors non-directly observable making the approximation a difficult issue. This paper provides an estimate of the indirect costs caused by a two weeks closure of the north–south Gotthard road corridor, one of the most important infrastructure links in Europe, and implements a cost–benefit analysis tool that allows the evaluation of measures ensuring a full protection along the corridor. The identification of the indirect cost relies on the generalized cost estimation, which parameters come from two stated preference experiments, the first based on actual condition whereas the second assumes a road closure. The procedure outlined in this paper proposes a methodology aimed to identify and quantify the economic vulnerability associated with a road transport infrastructure and, to evaluate the economic and social efficiency of a vulnerability reduction by the consideration of protective measures.

Venous Thromboembolism: A United States Cost Model for a Preventable and Costly Adverse Event,

Abstract 4224 Introduction.Venous thromboembolism (VTE) is comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a common cause of serious morbidity and mortality associated predominantly with hospitalization. The concept of “preventable” DVT has recently emerged in the medical literature. VTE remains the number one cause of preventable death in hospitalized patients.To date, VTE costs at a United States (US) national level for total costs, hospital-acquired costs, and “preventable” hospital-acquired costs have not yet been well-defined. Recently, investigators have defined US annual total, hospital-acquired, and preventable DVT costs ranged from $7.5 to $39.5 billion, $5 to $26.5 billion, and $2.5 to $19.5 billion, respectively, in 2010 US dollars. When a multi-way sensitivity analysis was applied, taking into consideration higher incidence rates and costs, annual US total, hospital-acquired, and “preventable” DVT costs ranged from $9.8 to $52 billion, $6.8 to $36 billion, and $3.4 to $27 billion, respectively. In addition, it was estimated that the US annual prophylaxis cost of at-risk patients is less than $600 million per year.PE costs have not yet been defined within the US. Defining PE costs would allow for definition of total US VTE costs on an annual basis. Methods.The authors undertook a thorough research review to identify morbidities, incident rates of morbidities, costs of morbidities and incidences of death associated with PE. Identified references were then hand-searched to ensure no pertinent publications had been overlooked. A decision tree and cost model were developed to estimate the United States healthcare costs for PE, total hospital-acquired PE, and total “preventable” PE. The decision tree contains probability information on: PE's that are hospital-acquired or community-acquired; fatal vs. non-fatal; readmissions; VTE recurrence; minor bleed; major bleed; heparin induced thrombocytopenia; chronic thromboembolic pulmonary hypertension; and resolution of symptoms.Based on the decision tree, a cost model with calculations performed via Microsoft Office Excel was developed. The cost model contains all potential outcomes, representing all branches, to reflect all possible outcomes for a PE patient. The product of each outcome's probabilities and costs yields the average cost of a patient going down that respective path of the PE decision tree. Similarly, each branch contains a sum that reflects the average cost of a patient in that branch. Results.Preliminary estimates of US annual direct total, hospital-acquired, and preventable PE costs are likely to range (at a minimum) from $5 to $27 billion, $2.5 to $18 billion, and $2.1 to $15.4 billion, respectively, in 2010 US dollars. Indirect costs, primarily from death due to PE, are estimated to be a minimum of $19.5 billion per year with approximately $11 billion per year of this being “preventable.”A multi-way sensitivity analysis will be applied which will take into consideration higher incidence rates and costs. Final results of the cost analysis, with the multi-way sensitivity analysis will be presented. Preliminary estimates suggest minimum total annualized, direct, VTE costs of approximately $12.5 to $66 billion per year with a minimum of $4.6 to $34.9 billion per year being “preventable.” When factoring in the indirect costs of $11 billion per year, minimum, “preventable” VTE costs within the US appear to range from $15.6 to $45.9 billion per year. Final results of the cost analysis with the multi-way sensitivity analysis will be presented. Conclusions.Considerable savings and reduced morbidity and mortality could be realized if improved prevention rates were achieved and systems were implemented throughout the US. To date, US VTE costs have been underestimated. The DVT and PE cost models may be applied to estimate costs in the European Union and other countries. VTE prophylaxis is cost effective and may be a good target for healthcare savings with healthcare reform on the horizon. Mandating VTE quality measures, such as those from the Joint Commission and National Quality Forum, would expedite reducing health care costs and reduce unnecessary morbidity and mortality. Disclosures:No relevant conflicts of interest to declare.

PRS22 Estimation of Direct and Inderct Costs of COPD in Ukraine: The Pilot Study Results

PRS22 Estimation of Direct and Inderct Costs of COPD in Ukraine: The Pilot Study Results

Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

In idiopathic trigeminal neuralgia (TN) the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1) a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol]), (2) the association of gabapentin (GBP) and analgesic block of trigger-points with ropivacaine (ROP) (GBP+ROP protocol), and (3) a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol). Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols) from cases of idiopathic TN, or selected for MVD surgery (n = 22) due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS) and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug therapies, while after MDV surgery several patients showed important side effects. Data reinforce that, (1) TN patients should be carefully evaluated before choosing therapy for pain control, (2) different pharmacological approaches are available to initiate pain control at low costs, and (3) criteria for surgical interventions should be clearly defined due to important side effects, with the initial higher costs being strongly reduced with time.

The direct healthcare insurer and out-of-pocket expenditures of psoriasis: evidence from a United States national survey

Objective: To quantify individual and national estimates of direct medical costs of psoriasis and similar disorders using national survey data. Methods: This was a retrospective study using 1996–2006 data from the Medical Expenditure Panel Survey (MEPS). Individuals' self-reported current health conditions were mapped to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes, whereby individuals with code 696 were categorized as having psoriasis. Healthcare services, for which healthcare costs were collected, included prescriptions and inpatient, outpatient, emergency room, office, and home health services. Out-of-pocket (OOP) costs were the portion of individuals' total payments for healthcare services. Results: There were 873 individuals with psoriasis (mean age = 51 years; 52% female) and 160 617 individuals without psoriasis (mean age = 48 years; 58% female). Annual per capita healthcare and OOP costs for individuals with psoriasis exceeded those for individuals without psoriasis ($4547 vs $3793, p < 0.001; $1255 vs $913, p < 0.001, respectively). United States national annual estimates of healthcare, OOP, and total direct medical expenses for psoriasis were $3.67 billion, $1.49 billion, and $5.17 billion, respectively. Conclusions: Direct medical costs associated with psoriasis are substantial to healthcare payers and patients. The extent to which appropriate and early diagnosis and treatment reduce total healthcare costs for individuals with psoriasis should be examined.

The cost of illness of atrial fibrillation: a systematic review of the recent literature

Atrial fibrillation (AF) is the most common cardiac arrhythmia, its prevalence increasing markedly with age. Atrial fibrillation is strongly associated with increased risk of morbidity, including stroke and thromboembolism. There is growing awareness of the economic burden of AF due to ageing populations and constrained public finances. A systematic review was performed (1990-2009). Cost studies for AF or atrial flutter were included; acute-onset and post-operative AF were excluded. Total, direct, and indirect costs were extracted. Of 875 records retrieved, 37 studies were included. The cost of managing individual AF patients is high. Direct-cost estimates ranged from $2000 to 14,200 per patient-year in the USA and from €450 to 3000 in Europe. This is comparable with other chronic conditions such as diabetes. The direct cost of AF represented 0.9-2.4% of the UK health-care budget in 2000 and had almost doubled over the previous 5 years. Inpatient care accounted for 50-70% of annual direct costs. In the USA, AF hospitalizations alone cost ∼$6.65 billion in 2005. In this first systematic review of the economic burden of AF, hospitalizations consistently represented the major cost driver. Costs and hospitalizations attributable to AF have increased markedly over recent decades and are expected to increase in future due to ageing populations.

O5-S3.03 Incremental cost-effectiveness of introducing partner notification with selective screening for STD control in Louisiana

BackgroundSelective screening and partner notification are the two strategies used by the STD control programs in USA to reduce and or eliminate syphilis. So far no study has assessed the...

High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model?

The aim of this paper was to provide a descriptive epidemiology of anterior cruciate ligament (ACL) reconstructions in Australia. Data on all ACL reconstructions were collected from July 1, 2003 till June 30, 2008. Main outcome measures were the incidence of ACL reconstructions for Australia, per age group, sex and sport, including estimates of direct costs. There were 50 187 ACL reconstructions over the 5-year period studied. The population-based incidence of ACL reconstructions per 100 000 person-years was 52.0 [95% confidence intervals (CI): 51.6; 52.5], higher than previously published incidences from other western countries (Scandinavia 32-38). The population incidence rose rapidly through adolescence and early adulthood and then gradually declined. Males had a higher population incidence than females. Skiing had the highest incidence of ACL reconstructions per 100 000 person-years, followed by Australian rules football, rugby, netball and soccer. The total estimated hospital costs associated with ACL reconstruction surgery were over A$75 million (€45 million) per year. Further research is necessary to examine the causes for the higher population incidence of ACL reconstructions in Australia compared with other countries. The establishment of a national register of ACL injuries, similar to those developed in Scandinavia should be considered.

Costs of asthma in the United States: 2002-2007

The economic burden of asthma is an important measure of the effect of asthma on society. Although asthma is a costly illness, the total cost of asthma to society has not been estimated in more than a decade. The purpose of this study is to provide the public with current estimates of the incremental direct medical costs and productivity losses due to morbidity and mortality from asthma at both the individual and national levels for the years 2002-2007. Data came from the Medical Expenditure Panel Survey. Two-part models were used to estimate the incremental direct costs of asthma. The incremental number of days lost from work and school was estimated by negative binomial regressions and valued following the human capital approach. Published data were used to value lives lost with an underlying cause of asthma. Over the years 2002-2007, the incremental direct cost of asthma was $3,259 (2009 dollars) per person per year. The value of additional days lost attributable to asthma per year was approximately $301 for each worker and $93 for each student. For the most recent year available, 2007, the total incremental cost of asthma to society was $56 billion, with productivity losses due to morbidity accounting for $3.8 billion and productivity losses due to mortality accounting for $2.1 billion. The current study finds that the estimated costs of asthma are substantial, which stresses the necessity for research and policy to work toward reducing the economic burden of asthma.