Indirect Economic Costs Research Articles

Demographic Profiles of Adult Trauma During a 5 Year Period (2007-2011) in Kashan, IR Iran

BackgroundTrauma, in addition to mortality and disability experienced by an individual, imposes direct and indirect economic and social costs on a community. Traditionally, trauma is a disease of young and middle age adults, an age group which is known to be the most dynamic and economically productive of the community. Increasing our knowledge concerning the etiology and patterns of trauma seems to be the most profitable and accessible way to prevent injuries of this nature.ObjectivesThis study was designed to evaluate the epidemiology of adult trauma in Kashan, Iran.Patients and MethodsThe current study used a retrospective cross-sectional approach, enrolling all trauma adults (20 - 60 y) admitted to the Shahid Beheshti Hospital, Kashan, between 2007 and 2011. Age, gender, place of residence, work status, educational level, urban/rural location of the accident, method of transportation to hospital, injured body areas of the victims and therapeutic interventions, were extracted from the data registry and analyzed through descriptive statistics using SPSS software.ResultsA total of 22 564 patients were included in this study. Mean age of the victims was 33.18 ± 10.90 years and the male/female ratio was 4:1. Most of the victims were manual workers (61%), and they had completed primary and junior high school level education (49.4%), they were also more likely to be residents of urban areas (88.6%). Regarding the place of injury, most accidents occurred on city streets (43.8%). Approximately 40% of the total victims were transferred to the hospital by emergency medical services (EMS). During the study period, 260 deaths were recorded and among these, 76% were related to traffic accidents.ConclusionsRegarding the high prevalence of trauma found in manual workers with low educational levels and motorbike users, the establishment of an integrated program aimed at improving public knowledge on the use of safety and protective measures in work environments should be implemented. The use of safety protective equipment by cyclists, motorbikers and car passengers should also be enforced.

The direct medical costs of colorectal cancer in Iran; analyzing the patient′s level data from a cancer specific hospital in Isfahan

The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. In this cross sectional study, the medical records of colorectal cancer (CRC) patients admitted to the Seyyed-al-Shohada Hospital "SSH" from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients' profiles and analyzed using Kruskal-Wallis test. The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 ± 13.4. More than Thirty-six percent of the patients were in stages 1-3 of CRC and more than half of them (64.4%) were in the 4(th) stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin (5FU/LV) was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 (±4927), for stage two 15920 (±3440), stage three 16452 (±2828) and for stage four was 16723 (±2555) US Dollars. The cost of drug treatment was the first cost driven between the medical services. CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million $. Screening programs could reduce the economic cost of CRC significantly.

Direct and Indirect Economic Costs Among Private-Sector Employees With Osteoarthritis

To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P < 0.01). Mean total direct costs among these persons were $17,751 and $5057, respectively (P < 0.01); 34% of health care costs among persons with OA arose from medical encounters with listed diagnoses of OA. Mean total indirect costs were two-fold higher among persons with OA ($5002 versus $2120 for those without OA; P < 0.01). Private-sector employees with OA have higher direct and indirect costs than those without this condition.

Economic costs attributable to smoking in China: update and an 8-year comparison, 2000–2008

ObjectiveTo estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective...

Burden of disease on road traffic injuries in Penglai city, Shandong province, in 2006 - 2007

To evaluate the burden of road traffic injury (RTI) from perspectives both on the health of population and on social economic status so as to provide scientific evidence for policy making. The status of mortality and disability caused by traffic accident in Penglai county was estimated, based on data from death registration and a sampling survey from 2006 to 2007. Together with the disability weights gained from global burden of disease (GBD), health burden (DALY) was measured with GBD formula. The economic burden of RTI was evaluated. Average loss of the health life years (HLY) related to RTI was 31 373.04 per year. 70.59 HLY were lost per 1000 persons. Loss among the males was higher than females. The loss of DALY among the age group 15 - 44 years ranked the first place (39 209.71 HLY) which accounted for 62.42% of the total DALY. 79.45% of the total DALY were caused by disability. In 2006 and 2007, the economic loss caused by RTI was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP while the indirect economic costs (2.15 billion RMB) accounted for 98.45% of the total costs in Penglai city. The economic loss of the males was obviously higher than the females and the loss by the group aged 15 - 59 years old accounted for 97.65% of the total. RTI had severely influenced the health of the residents in Penglai city and brought heavy burden to the individuals, families as well as the society.

Household costs associated with food allergy: an exploratory study

Purpose – Food allergy has potential to affect direct, indirect and intangible economic costs experienced by food allergic individuals and their families, resulting in negative impacts on welfare and well‐being. The purpose of this paper is to develop an instrument to assess these economic costs of food allergy at household level and to conduct an exploratory analysis of potential economic impact.Design/methodology/approach – A case‐controlled postal pilot survey was conducted using a self‐completion instrument. Cases had either clinically or self‐diagnosed food allergy. Controls were obtained from households in which none of the members had food allergies.Findings – The instrument appeared sensitive to the economic cost differences between households with and without food allergic members. Direct costs of health care were significantly higher for cases than for controls. Similar differences were identified for indirect cost of lost earnings, and costs due to inability to perform domestic tasks because of...

Effects of Prior Authorization on Medication Discontinuation Among Medicaid Beneficiaries With Bipolar Disorder

Few data exist on the cost and quality effects of increased use of prior-authorization policies to control psychoactive drug spending among persons with serious mental illness. This study examined the impact of a prior-authorization policy in Maine on second-generation antipsychotic and anticonvulsant utilization, discontinuations in therapy, and pharmacy costs among Medicaid beneficiaries with bipolar disorder. Using Medicaid and Medicare utilization data for 2001-2004, the authors identified 5,336 patients with bipolar disorder in Maine (study state) and 1,376 in New Hampshire (comparison state). With an interrupted time-series and comparison group design, longitudinal changes were measured in second-generation antipsychotic and anticonvulsant use; survival analysis was used to examine treatment discontinuations and rates of switching medications. The prior-authorization policy resulted in an 8-percentage point reduction in the prevalence of use of nonpreferred second-generation antipsychotic and anticonvulsant medications (those requiring prior authorization) but did not increase use of preferred agents (no prior authorization) or rates of switching. The prior-authorization policy reduced total pharmacy reimbursements for bipolar disorder by $27 per patient during the eight-month policy period. However, the hazard rate of treatment discontinuation (all bipolar drugs) while the policy was in effect was 2.28 (95% confidence interval=1.36-4.33) higher than during the prepolicy period, with adjustment for trends in the comparison state. The small reduction in pharmacy spending for bipolar treatment after the policy was implemented may have resulted from higher rates of medication discontinuation rather than switching. The findings indicate that the prior-authorization policy in Maine may have increased patient risk without appreciable cost savings to the state.

Clinical Immunology Review Series: An approach to the patient with allergy in childhood

Allergic conditions are common, with asthma being the most common chronic illness in childhood in most developed countries. Some 80% of asthmatic children are sensitized to aeroallergens, usually indoor animal dander and house dust mite. Some 80% of asthmatics also have rhinitis. Rhinitis and eczema receive less medical attention than asthma, but they can cause longterm morbidity and have substantial direct and indirect economic costs. Food allergy and anaphylaxis are increasingly recognised and are usually easily diagnosed and managed.Clinicians can use in vivo and in vitro measurements of allergen-specific immunoglobulin E to better time reintroduction of implicated foods. Specific parenteral and sublingual immunotherapy is widely practiced internationally but is uncommon in the UK. It may alter the natural history of aeroallergen reactive diseases in the upper and lower airways. Specific oral tolerance induction represents the current cutting edge in clinical allergy research. It remands resource intensive at present and cannot be adopted into routine clinical practice at this time.

Preventing violence and reducing its impact: how development agencies can help

Violence has long been considered a criminal justice and human rights issue. More recently it has also been viewed as a public health problem. But violence has rarely been regarded...

Economic cost of malaria on households during a transmission season in Khartoum State, Sudan

This study was conducted in 2004 among 1200 households in Khartoum to estimate the direct and indirect economic costs of malaria for households. Information on the household and the malaria episodes was collected (care-seeking behaviour, working days lost and expenditure on malaria treatment). There were 327 episodes of malaria; 25.2% of the households reported at least 1 malaria episode during the month preceding the survey. In only 18.0% of malaria episodes was the individual economically active. The average treatment expenditure per fully cured case was US$ 6.3 (SD 5.9). The average indirect cost per fully cured case was U.S. $3.2 (SD 9.2); it was higher for individuals working in the informal sector than those employed in the formal sector.

A Systematic Review Evaluating Health-Related Quality of Life, Work Impairment, and Health-Care Costs and Utilization in Abnormal Uterine Bleeding

Objective Abnormal uterine bleeding (AUB) impacts women's health-related quality of life (HRQoL) and puts a heavy economic burden on society. To date, this burden has not been systematically studied. We conducted a systematic review of the medical literature to evaluate the impact of AUB on HRQoL and to quantify the economic burden of AUB from a societal perspective. Methods We searched the PubMed and Cochrane databases, and article bibliographies for the period up to July 2005. Teams of two reviewers independently abstracted data from studies that reported outcomes of interest: prevalence, HRQoL, work impairment, and health-care utilization and costs associated with AUB. Results The search yielded 1009 English-language articles. Ninety-eight studies (including randomized controlled trials, observational studies, and reviews) that met the inclusion and exclusion criteria underwent a full-text review. The prevalence of AUB among women of reproductive age ranged from 10% to 30%. The HRQoL scores from the 36-item Short-Form Health Survey Questionnaire (SF-36) suggested that women with AUB have HRQoL below the 25th percentile of that for the general female population within a similar age range. The conservatively estimated annual direct and indirect economic costs of AUB were approximately $1 billion and $12 billion, respectively. These figures do not account for intangible costs and productivity loss due to presenteeism. Conclusion The burden of AUB needs further and more thorough investigation. Additional research should prospectively evaluate the impact of AUB and the value of treatment provided to help guide future health resource allocation and clinical decision-making.

Vesicoureteral Reflux and Ureteroceles

We quantified the burden of vesicoureteral reflux and ureteroceles in the United States by identifying trends in the use of health care resources and estimating the economic impact of the diseases. The analytical methods used to generate these results were described previously. Annual inpatient hospitalizations for vesicoureteral reflux increased slightly between 1994 and 2000 from 6.4/100,000 to 7.0/100,000 children, although this trend did not attain statistical significance. Inpatient hospitalization for ureteroceles remained relatively stable between 1994 and 2000 at an average of approximately 2,818 cases annually (1.0/100,000 to 1.1/100,000 children). The rates of visits to physician offices doubled during the 1990 s for commercially insured children (12/100,000 in 1994 and 26/100,000 in 2002) and children covered by Medicaid (43/100,000 in 1996 and 85/100,000 in 2000). Overall the rate of ambulatory surgery visits by commercially insured children increased from 3.4/100,000 in 1998 to 4.8/100,000 in 2002. Similar estimates were not available for children covered by Medicaid. Emergency room use by children with a primary diagnosis of vesicoureteral reflux was rare, reflecting the trend toward delivery of care at physician offices, ambulatory surgery centers and inpatient hospitals. No reliable data could be obtained on outpatient visits or ambulatory surgery for ureteroceles. In 2000 total expenditures for inpatient pediatric vesicoureteral reflux were $47 million, an increase of more than $10 million since 1997. Based on data from 2000 the yearly national inpatient expenditures from ureterocele treatment were an estimated $4 million. The economic impact of inpatient treatment for pediatric vesicoureteral reflux is considerable. If other service types such as pharmaceuticals, and outpatient and ambulatory services were considered, the observed impact of this condition would certainly be greater. Importantly the costs of prophylactic medical therapy and emerging therapies such as Deflux are not accounted for in this estimate. Furthermore, indirect economic costs, such as work loss to parents of children with pediatric vesicoureteral reflux, were not considered, causing an even greater underestimation of the true costs associated with the condition. Although the National Association of Children's Hospitals and Related Institutions, and the Health Care Cost and Utilization Project Kids' Inpatient Database include data on ureteroceles, the data were limited and, thus, they could not be used to determine reliable cost trends. Available data indicate that the mean cost per ureterocele case was almost $8,000 with little variation observed across ages, regions or sexes.

Physical activity and health: Metabolic and cardiovascular issues

Currently, chronic non-communicable diseases, notably metabolic and cardiovascular diseases, are a major health-related burden of the populations of the industrialized and increasingly so also of the non-industrialized countries. Physical inactivity is one of the living habits that have been shown to be causally related to the most common metabolic and cardiovascular conditions, namely obesity, type 2 diabetes, metabolic syndrome, hypertension, coronary heart disease, stroke and peripheral arterial disease. The World Health Report 2002 estimates that globally the prevalence of physical inactivity among adults is at least 17%, and that of insufficient activity 41%, and that physical inactivity causes 1.9 million deaths and loss of 19 million disability-adjusted life-years (DALYs) annually, related to the health losses caused by coronary heart disease, stroke, breast cancer, colon cancer and type 2 diabetes. In Australia, DALY losses due to physical inactivity rank second (tobacco being first) among males and first among females. In Canada, physical inactivity is estimated to be attributable to 35.8% of coronary heart disease, 19.9% of stroke, 19.9% of hypertension, 19.9% of colon cancer, 11.0% of breast cancer and 19.9% of type 2 diabetes. The direct and indirect economic costs of physical inactivity in Canada are estimated to be 2.6% and those of obesity 2.2% of the total healthcare costs. These figures suggest that reaching sufficient levels of physical activity would decrease substantially the disease burden caused by metabolic and cardiovascular diseases. Evidence from a large number of observational studies and also from controlled trials indicates that the amount, strenuousness and type of physical activity needed to gain a substantial part of the potential health benefits is in principle feasible and safe for the majority of the people in industrial societies. However, changing physical activity habits at individual and especially at the population level have proved to be difficult. Therefore, effective measures are needed to increase people's opportunities and motivation to incorporate more physical activity into their daily lives. Healthcare personnel, particularly physiotherapists, have good opportunities to contribute to this important work.

Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India

To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. The total cost of care per episode of VL from the societal perspective was estimated at US$355, equivalent to 58% of annual household income. The largest cost category was medical costs (55%), followed by indirect costs (36%) and non-medical costs (9%). The cost from the household perspective was equivalent to US$217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL.

Mental Retardation: Diagnosis, Management, and Family Support

T he direct and indirect economic costs associated with mental retardation in the United States are significant: 51.2 billion dollars (2003 dollars) for persons born in 2000. This represents a significant and ongoing economic impact, especially since the beneficial effect of numerous intervention and prevention programs such as newborn screening for metabolic disorders (phenylketonuria, hypothyroidism) have likely already been realized by the time of this birth cohort. There continue to be multiple etiologies for mental retardation despite the successful interventions directed at these high-severity, lowfrequency disorders. Lifetime indirect costs (ie, productivity losses) far exceed direct health and educational costs, emphasizing the need to address the physical, social, and economic factors that limit the functional participation of persons with mental retardation. The number of children classified as “mentally retarded” receiving services in federally funded educational programs has stabilized over the past 9 years between 1.26 and 1.28%. During this same period, the number of children identified as “learning disabled” or as having “autism” has increased. Educational support remains a primary intervention for individuals with all levels of mental retardation and is guaranteed under the Individuals with Disabilities Education Act. It is for these reasons that better efforts to understand the reasons for mental retardation and to develop effective strategies to both prevent, whenever possible, and minimize the impact of mental retardation on individuals, their families, and their communities continue to be important.

The direct and indirect economic costs incurred by living kidney donors—a systematic review

Despite the many benefits of living donor kidney transplantation, economic consequences can result for donors. We reviewed studies which quantified the direct and indirect costs incurred by living kidney donors, in order to understand the strengths and limitations of existing literature. We identified relevant studies in MEDLINE, EMBASE and ECONOLIT bibliographic databases, in the Science Citation Index and study reference lists. Any study which reported at least one cost relevant to donors was included. The accuracy of abstracted data was verified by two reviewers and reported in year 2004 US dollars. Thirty-five studies from 12 countries described costs incurred by individuals who donated between the years 1964 and 2003. No study comprehensively quantified all relevant expenses-the sum of select costs considered in one US study averaged Dollars 837 per donor and ranged from Dollars 0 to 28,906. Travel and/or accommodation costs were incurred by 9-99% of donors, and were higher in countries with a larger land mass. Post-discharge analgesics were required by 4-24% of donors, but prescription costs were not reported. Between 14 and 30% of donors incurred costs for lost income, with an average loss of Dollars 3386 in one study from the UK and Dollars 682 in another study from the Netherlands. Costs for dependent care were incurred by 9-44% of donors, while costs for domestic help were incurred by 8% of donors. Donors incur many types of costs attributable to kidney donation and the total costs are certainly higher than previously reported. To guide informed consent and fair reimbursement policies, further data on all relevant costs, preferably from a detailed prospective multi-centre cohort study, are required.

Individual and Social Costs of Divorce in Utah

This preliminary report provides an overview of the economic consequences of divorce for couples experiencing divorce in Utah. The economic impact on the divorcing individuals, the surrounding communities in which they live, and the state and federal governments were assessed. The data collected in Utah reveals that the federal government absorbs the most substantial costs, including a host of expenditures related to welfare assistance and medical costs. The 9,735 divorces in Utah during 2001 cost the state and federal government nearly $300 million in direct and indirect costs. Extrapolation from these estimates reveals that divorce and its direct and indirect economic consequences cost the United States $33.3 billion annually. Implications for social policy and strengthening marriages are provided.

Evaluación del implante coclear como técnica de tratamiento de la hipoacusia profunda en pacientes pre y post locutivos

IntroductionThese are the objectives planned for this study: 1. Evaluate the results from the communication point of view. 2. Evaluate the cochlear implant (CI) impact on the quality of life. 3. Evaluate medical complications and technical failures. 4. Assess direct and indirect costs generated during the phases of a cochlear implantation programme. 5. Determine which factors have a high impact on the clinical evolution and the financial cost Materials and MethodA population of 877 patients, postlingual and prelingual, adults and children, have been studied. They were treated in 5 Spanish centres with cochlear implant programmes. Audiometric tests and global questionnaires on life quality have been carried out. Medical and CI technology complications have also been computed. Direct and indirect economic costs of a cochlear implant have been calculated ResultsPostlocutive-implanted patients reached the 40 dB SPL threshold in the Pure Tone Audiometry, and this result was maintained during the 12-year evolution. In Vowels test, it evolved from a 30% on pre-stimulation to 80-90%, in Disyllables words test it evolved from a 10% to a 50-60%, and in CID Sentences test it evolved from an 18% to a 60-70%. In the prelocutive population, results were influenced by the child’s age at implantation. The best results were obtained by the children who had been implanted earlier. Those implanted between 0 and 3 years old evolved in the Vowels test from 0% during pre-stimulation to 95%, from a 0% to a 90% in Disyllables words test and from a 0% to a 90-95% in CID Sentences test. Also, the speech acquisition and development of the pre-locutive population was also influenced by the implantation age. An 80% of postlocutive adult patients stated a mood and sociability improvement after the cochlear implantation. They did not show health changes in general nor relevant modifications in the attention they usually received from relatives and friends. Severe medical-surgical complications were registered for a 3.42% of the cases, a 7.06% of mild medical-surgical complications and a 3.07% of technical breakdowns in the internal components of the CI. Financial cost of implantation for a post-locutive adult oscillated between 36,912€ and 37,048€, and between 37,689€ and 44,273€ for a pre-locutive child ConclusionsCochlear implants clearly enhance communication skills of the implantees. Results obtained for the prelocutive implanted population justify the creation of hearing screening programmes in new-borns. Postlocutive implanted adults have expressed satisfaction for the results obtained. However, they did perceive some limitations in situations of unfavourable acoustic conditions. An analysis of direct and indirect costs related to a CI programme has been made. It may be useful to carry out reports on the cost-benefit ratio in this field. The low index of complications observed shows which cochlear implant treatment technique complies with the adequate safety margins. The factors influencing the most in the evolution are: duration of hearing deprivation, age at implantation, cochlear anatomy and functionality of the auditory pathway, patient’s and relative’s motivation, and the coexistence of other handicaps associated to hearing losses

The burden caused by injury in countryside residents in Dongying, Shandong Province

To make clear the burden of injury in residents living in countryside of Dongying, Shandong Province. A retrospective questionnaire survey was conducted among 15,276 residents in 20 villages of Dongying Municipality of Shandong Province with a multiphase cluster randomly sampling on cases of injury from March 1, 2002 to February 28, 2003. The injury was decided with three principles which had been carried out through the nation. The standardized incidence and mortality rates were calculated on base of the population data of Shandong Province in 2000. The burden of injury was evaluated by incidence rate, mortality rate, years of potential life lost (YPLL) system, disability adjusted life year (DALY), direct and indirect economic costs, et al. Totally 902 were injured cases in which the crude incidence rate was 5.90%, and the standardized incidence rate was 5.93%. It was shown higher in men (7.79%) than in women (4.03%). The crude death rate was 12.438 per million. And the standardized death rate was 11.257 per million. 27 cases were crippled. The years, the working years and the valued years of the potential life lost were 24, 19.6 and 8.7 years respectively for each death case. Disability adjusted life years was 566.61 years. Direct economic cost for medical expenses of all cases was 816.3 thousand RMB Yuan and 200.1 thousand RMB Yuan for else costs. Indirect economic cost was 5,492.9 thousand RMB Yuan according to DALY. Injury was common incidence in rural residents in Dongying which caused a heavy burden on them. Prevention and control of injuries would be enhanced.

Acute bacterial rhinosinusitis: Clinical impact of resistance and susceptibility

Sinusitis is a common disorder associated with notable direct and indirect economic costs. Acute bacterial rhinosinusitis (ABRS) is a relatively poorly defined clinical syndrome characterized by a high spontaneous resolution rate, wide variations in presenting symptoms, and an incomplete understanding of the pathogenesis and clinical course of the disease. Streptococcus pneumoniae and Haemophilus influenzae are the most common causative pathogens in adult ABRS. A relative lack of bacteriological eradication data compared with other respiratory illnesses, uncertainty on the part of many clinicians as to when to treat, and increasing rates of antimicrobial resistance hamper logical treatment strategies. Because it is impossible to know which cases of ABRS will spontaneously resolve and which will not, antimicrobials are recommended. In general, antimicrobial treatment for ABRS should cover both S pneumoniae and H influenzae while considering the risk of infection with resistant organisms. Treatment guidelines for ABRS were developed by the Sinus and Allergy Health Partnership in 2000 and were updated in 2004. This article discusses a Sinusitis Therapeutic Outcome Model, a data-driven model used in the development of the treatment guidelines, with respect to different scenarios involving ABRS to illustrate the implications of antimicrobial selection on therapeutic outcome.