Individual Costs Research Articles

The Effects of Violence against U.S. Officeholders

Abstract Using an original 2021 survey of mayors in U.S. mayors in cities of 10,000 in population and above, we explore the individual costs of psychological and physical violence. These costs include emotional distress, diverted attention from the job, and considerations about leaving the job. Overall, we find that 95 percent of mayors faced violence in office. Among those who did, the more violence reported, the more likely they were to have faced such costs. Further, those mayors (mostly women) who faced sexualized violence were more likely to have reported those effects. All told, violence against officeholders has individual effects as well as systemic ones. If violence keeps mayors from being able to do their job fully or causes them to leave it, the political costs may be quite grave in terms of losing experienced representatives—and it may also have disparate effects on particular groups of officeholders, such as women.

Approximate Sketches

Sketches are single-pass small-space data summaries that can quickly estimate the cardinality of join queries. However, sketches are not directly applicable to join queries with dynamic filter conditions --- where arbitrary selection predicate(s) are applied --- since a sketch is limited to a fixed selection. While multiple sketches for various selections can be used in combination, they each incur individual storage and maintenance costs. Alternatively, exact sketches can be built during runtime for every selection. To make this process scale, a high-degree of parallelism --- available in hardware accelerators such as GPUs --- is required. Therefore, sketch usage for cardinality estimation in query optimization is limited. Following recent work that applies transformers to cardinality estimation, we design a novel learning-based method to approximate the sketch of any arbitrary selection, enabling sketches for join queries with filter conditions. We train a transformer on each table to estimate the sketch of any subset of the table, i.e., any arbitrary selection. Transformers achieve this by learning the joint distribution amongst table attributes, which is equivalent to a multidimensional sketch. Subsequently, transformers can approximate any sketch, enabling sketches for join cardinality estimation. In turn, estimating joins via approximate sketches allows tables to be modeled individually and thus scales linearly with the number of tables. We evaluate the accuracy and efficacy of approximate sketches on queries with selection predicates consisting of conjunctions of point and range conditions. Approximate sketches achieve similar accuracy to exact sketches with at least one order of magnitude less overhead.

Modelling autonomous vehicle parking: An agent‐based simulation approach

AbstractAutonomous vehicles (AVs) present a paradigm shift in addressing conventional parking challenges. Unlike human‐driven vehicles, AVs can strategically park or cruise until summoned by users. Utilizing utility theory, the parking decision‐making processes of AVs users are explored, taking into account constraints related to both cost and time. An agent‐based simulation approach is adopted to construct an AV parking model, reflecting the complex dynamics of the parking decision process in the real world, where each user's choice has a ripple effect on traffic conditions, consequently affecting the feasible options for other users. The simulation experiments indicate that 11.50% of AVs gravitate towards parking lots near their destinations, while over 50% of AVs avoid public parking amenities altogether. This trend towards minimizing individual parking costs prompts AVs to undertake extended empty cruising, resulting in a significant increase of 48.18% in total vehicle mileage. Moreover, the pricing structure across various parking facilities and management dictates the parking preferences of AVs, establishing a nuanced trade‐off between parking expenses and proximity for these vehicles.

Understanding Pathways into Care-homes using Data (UnPiCD study): a two-part model to estimate inpatient and care-home costs using national linked health and social care data

BackgroundPathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community.MethodsUsing routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission.ResultsWe included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750).ConclusionIndividuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision.

Medical Costs Associated with High/Moderate/Low Likelihood of Adult Growth Hormone Deficiency: A Healthcare Claims Database Analysis.

Adult growth hormone deficiency (AGHD) is often underdiagnosed and undertreated, leading to costly comorbidities. Previously, we developed an algorithm to identify individuals in a commercially insured US population with high, moderate, or low likelihood of having AGHD. Here, we estimate and compare direct medical costs by likelihood level. Retrospective, observational analysis using the Truven Health MarketScan database to analyze direct medical costs relating to inpatient and outpatient claims, outpatient prescription claims, medication usage, clinical utilization records, and healthcare expenditures. Patients were categorized into groups based on algorithmically determined likelihoods of AGHD. Likelihood groups were further stratified by age and sex. Trajectories of annual costs (USD) by likelihood level were also investigated. The study cohort comprised 135million US adults (aged ≥18years). Individuals ranked as high-likelihood AGHD had a greater burden of comorbid illness, including cardiovascular disease and diabetes, than those ranked moderate- or low-likelihood. Those in the high-likelihood group had greater mean total direct medical monthly costs ($1844.51 [95% confidence interval (CI): 1841.24;1847.78]) than those in the moderate- ($945.65 [95% CI: 945.26;946.04]) and low-likelihood groups ($459.10 [95% CI: 458.95;459.25]). Outpatient visits accounted for the majority of costs overall, although cost per visit was substantially lower than for inpatient services. Costs tended to increase with age and peaked around the time that individuals were assigned a level of AGHD likelihood. Total direct medical costs in individuals with a high likelihood of AGHD exceeded those for individuals with moderate or low likelihood. Understanding the trajectory of healthcare costs in AGHD may help rationalize allocation of healthcare resources.

Convergence Analysis of Distributed Gradient Descent Algorithms With One and Two Momentum Terms

For the centralized optimization, it is well known that adding one momentum term (also called the heavy-ball method) can obtain a faster convergence rate than the gradient method. However, for the distributed counterpart, there is quite few results about the effect of added momentum terms on the convergence rate. This article is aimed at studying the issue in the distributed setup, where N agents minimize the sum of their individual cost functions using local communication over a network. The cost functions are twice continuously differentiable. We first study the algorithm with one momentum term and develop a distributed heavy-ball (D-HB) method by adding one momentum term on to the distributed gradient algorithm. By borrowing tools from the control theory, we provide a simple convergence proof and an explicit expression of the optimal convergence rate. Furthermore, we consider adding two momentum terms case and propose a distributed double-heavy-ball (D-DHB) method. We show that adding one momentum term allows faster convergence while adding two momentum terms does not perform any superiorities. Finally, simulation examples are given to illustrate our findings.

A better integration of health and economic impact assessments of climate change

Climate change could lead to high economic burden for individuals (i.e. low income and high prices). While economic conditions are important determinants of climate change vulnerability, environmental epidemiological studies focus primarily on the direct impact of temperature on morbidity and mortality without accounting for climate-induced impacts on the economy. More integrated approaches are needed to provide comprehensive assessments of climate-induced direct and indirect impacts on health. This paper provides some perspectives on how epidemiological and economic impact assessments could be better integrated. We argue that accounting for the economic repercussions of climate change on people’s health and, vice versa, the consequences of health effects on the economy could provide more realistic scenario projections and could be more useful for adaptation policy.

Does Body Mass Index Influence Intraoperative Costs and Operative Times for Anterior Cervical Discectomy and Fusion? A Time-Driven Activity-Based Costing Analysis

ObjectiveSpine surgeons are often unaware of drivers of cost variation for anterior cervical discectomy and fusion (ACDF). We used time-driven activity-based costing (TDABC) to assess the relationship between body mass index (BMI), total cost, and OR times for ACDFs. MethodsTotal cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for all involved personnel and material resources were documented. Total intraoperative costs were estimated for all ACDFs from 2017 and 2022. All patients were categorized into distinct BMI-based cohorts. Linear regression models were performed to assess the relationship between BMI, total cost, and OR times. ResultsA total of 959 patients underwent ACDFs between 2017 and 2022. The average age and BMI were 58.1 ± 11.2 years and 30.2 ± 6.4 kg/m2, respectively. The average total intraoperative cost per case was $7,120 ± $2,963. Multivariable regression analysis revealed that BMI was not significantly associated with total cost (p=0.36), supply cost (p=0.39), or personnel cost (p=0.20). Higher BMI was significantly associated with increased time spent in the OR (p=0.018); however, it was not a significant factor for the duration of surgery itself (p=0.755). Rather, higher BMI was significantly associated with non-operative OR time (p<0.001). ConclusionTDABC is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF. Although higher BMI was not associated with increased total cost, it was associated with increased preparatory time in the OR.

Kajian Desain Pemanen Air Hujan Tipe Individual dan Komunal, (Studi Kasus: Desa Sawojajar, Kecamatan Wanasari, Kabupaten Brebes, Jawa Tengah)

Climate change and geographic location affect water availability. Coastal areas in Indonesia generally have drinking water problems because the well water is dry due to the dry season and the water is brackish, as is the case in Sawojajar Village in Brebes Regency, Central Java. On the other hand, the potential for rainwater in Sawojajar Village is quite good. The Brebes Regency Government is planning and implementing a rain harvesting (Gama Rain Filter) with an individual type for people who want to install rainwater harvestings in their homes, and a communal type for people who still want communal rainwater harvestings. This applied research aims to compare the two types. The individual type planning method for harvesting rain is carried out in each house and the communal type planning method is carried out in groups of houses. The planning carried out includes checking the quality and quantity of rainwater, calculating the dimensions of the storage tank, design drawings, and planning and implementation budget plans. The results of this applied research are the quality and quantity of rainwater, the design of individual and communal type rainwater harvestings, and the planning costs and implementation costs required. This research resulted in the conclusion that the individual type rain harvesting is more recommended than the communal type because the individual type costs less to plan and construct, is more flexible in placement, easier to manufacture, and maintains operations more securely.

Impact of coronavirus disease 2019 on cancer care: How the pandemic has changed cancer utilization and expenditures.

Since identified in December 2019, the novel coronavirus disease 2019 (COVID-19) has had a global impact on medical resource use and costs for patients with cancer in South Korea. This study aimed to identify the medical use and costs among patients with cancer during the COVID-19 pandemic, to predict these patterns in South Korea in the future. We conducted a secondary claims data analysis using the National Health Insurance Service database for the calendar period of 2019-2020. Monthly relative percent changes in cancer incidence, medical use, and billing costs for medical care utilization by cancer type were calculated. Then, the medical use and costs after January 2020 were predicted using a time series model with data before the COVID-19 outbreak (2014-2019). The incidence of cancer diagnoses has seen a notable decline since the outbreak of the COVID-19 in 2020 as compared to 2019. Despite the impact of COVID-19, there hasn't been a distinct decline in outpatient utilization when compared to inpatient utilization. While medical expenses for both inpatient and outpatient visits have slightly increased, the number of patients treated for cancer has decreased significantly compared to the previous year. In June 2020, overall outpatient costs experienced the highest increase (21.1%), while individual costs showed the most significant decrease (-4.9%) in June 2020. Finally, the number of hospitalisations and outpatient visits increased slightly from June-July in 2020, reducing the difference between the actual and predicted values. The decrease in the number of inpatient hospitalisations (-22~-6%) in 2020 was also high. The overall use of medical services by patients with cancer decreased in 2020 compared with that in the pre-COVID-19 pandemic period. In the future, the government should consider how to recover from the COVID-19 pandemic, and establish permanent health policies for patients with cancer.

Abstract WP229: Comparing the Real-World Effects of Once-Weekly Semaglutide and Dipeptidyl Peptidase-4 Inhibitors on Cardiovascular Outcomes, Health Care Resource Utilization, and Medical Costs in Individuals With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

When compared with placebo, glucagon-like peptide-1 receptor agonists such as once-weekly semaglutide (semaglutide OW T2D) improve cardiovascular outcomes in people with type 2 diabetes (T2D), whereas dipeptidyl peptidase-4 inhibitors (DPP-4is) do not. However, no head-to-head trials of these 2 incretin-based drug classes have been conducted. This retrospective cohort study used 2018-2022 data from the Optum ® Clinformatics ® Data Mart to compare on-treatment time with incidence of ischemic stroke, myocardial infarction (MI), and 2-point major adverse cardiovascular events (MACE; composite of ischemic stroke and MI); health care resource utilization; and medical costs in new adult users of semaglutide OW T2D and DPP-4is with T2D and atherosclerotic cardiovascular disease (ASCVD). Patients were followed until drug discontinuation, enrollment end, or an event. Baseline characteristics ( Table ) were balanced using inverse probability of treatment weighting. On average, patients were aged 70 years, with 5.6- and 4.3-year history of T2D and ASCVD, respectively. Survival analyses were conducted to compare risks during exposure. Users of semaglutide OW T2D (weighted n=14,461) had 46%, 36%, and 40% lower relative risk of ischemic stroke, MI, and 2-point MACE, respectively, compared with users of DPP-4is (weighted n=38,630; all P ≤0.001; Figure ). Users of semaglutide OW T2D also had decreased ASCVD-related and all-cause hospitalizations, outpatient visits, hospitalization costs, and total medical costs (all P &lt;0.05). This study suggests that semaglutide OW T2D reduces the risk of stroke and MI while reducing medical costs relative to DPP-4is in adults with T2D and ASCVD.

Cost analysis of water charge rates in the Czech Republic – Case study

The article was conceived as an initial insight into the issues related to the representation of individual type costs (e.g. material, labor costs, property depreciation, etc.) in the price of water in the Czech Republic. The aim of the article was to point out the possibility of dependence between the size of the company operating the infrastructural property of water supply and sewerage and the representation of individual costs in the water price within the framework of the case study. As a sample that formed the outputs of the case study, 14 companies were taken, which were selected according to the unified regions of the Czech Republic. Both basic mathematical methods and elementary methods used in financial analysis were used in the analysis. Within the scope of the case study, it can be stated that there is no dependence between the size of the companies and the representation of costs. Among the largest costs from the point of view of financial representation are other direct costs, where the costs of depreciation, property repairs, rental property, as well as wage costs and material costs are mainly represented. Insignificant costs include, for example, energy costs, which are only represented in the range of 1.39–5.70% of the total costs. Therefore, in order for the results included in the case study to be considered statistically relevant, it is necessary to expand the sample and confirm or refute the initial findings published in this article.

Better Together: 14-Month-Old Infants Expect Agents to Cooperate.

Humans engage in cooperative activities from early on and the breadth of human cooperation is unparalleled. Human preference for cooperation might reflect cognitive and motivational mechanisms that drive engagement in cooperative activities. Here we investigate early indices of humans' cooperative abilities and test whether 14-month-old infants expect agents to prefer cooperative over individual goal achievement. Three groups of infants saw videos of agents facing a choice between two actions that led to identical rewards but differed in the individual costs. Our results show that, in line with prior research, infants expect agents to make instrumentally rational choices and prefer the less costly of two individual action alternatives. In contrast, when one of the action alternatives is cooperative, infants expect agents to choose cooperation over individual action, even though the cooperative action demands more effort from each agent to achieve the same outcome. Finally, we do not find evidence that infants expect agents to choose the less costly alternative when both options entail cooperative action. Combined, these results indicate an ontogenetically early expectation of cooperation, and raise interesting implications and questions regarding the nature of infants' representations of cooperative actions and their utility.

Constrained Community Detection and Multistage Multicost Consensus in Social Network Large-Scale Decision-Making

As a widely encountered decision-making scenario in modern society, social network large-scale decision-making (SNLSDM) is becoming a frontier topic in the field of decision science. Decision information usually includes social relationships among decision-makers (DMs) and individual opinions. This makes clustering and consensus building, which are two important processes for solving SNLSDM problems, significantly complex and requires the integration of multiple factors. This study designs a decision support method that consists of a constrained community detection (CCD) method and a multistage multicost consensus (MSMulCC) model. The CCD method takes the similarities among individual opinions as the mandatory constraint to guide the classification of DMs based on social relationships. The consensus-reaching process (CRP) is an effective tool for reducing differences of opinion. We hold that the DM with high compatibility but low consensus can reduce the adjustment amount by actively losing some compatibility. In this way, three types of consensus costs are generated, including individual adjustment cost, group adjustment cost, and compatibility loss cost. In this study, an MSMulCC model is developed, and the impact of different types of consensus costs on CRP. Finally, the feasibility and characteristics of the proposal are revealed through a case study and comparative analysis of the supply chain financing model selection.

Primary and secondary care service use and costs associated with frailty in an ageing population: longitudinal analysis of an English primary care cohort of adults aged 50 and over, 2006-2017.

Frailty becomes more prevalent and healthcare needs increase with age. Information on the impact of frailty on population level use of health services and associated costs is needed to plan for ageing populations. To describe primary and secondary care service use and associated costs by electronic Frailty Index (eFI) category. Retrospective cohort using electronic health records. Participants aged ≥50 registered in primary care practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre, 2006-2017. Primary and secondary care use (totals and means) were stratified by eFI category and age group. Standardised 2017 costs were used to calculate primary, secondary and overall costs. Generalised linear models explored associations between frailty, sociodemographic characteristics. Adjusted mean costs and cost ratios were produced. Individual mean annual use of primary and secondary care services increased with increasing frailty severity. Overall cohort care costs for were highest in mild frailty in all 12years, followed by moderate and severe, although the proportion of the population with severe frailty can be expected to increase over time. After adjusting for sociodemographic factors, compared to the fit category, individual annual costs doubled in mild frailty, tripled in moderate and quadrupled in severe. Increasing levels of frailty are associated with an additional burden of individual service use. However, individuals with mild and moderate frailty contribute to higher overall costs. Earlier intervention may have the most potential to reduce service use and costs at population level.

Tedarik Zinciri Boyunca Sebze Kayıpları ve Atıkları, Geri Dönüşüm İçin Çiftçinin Ödeme İstekliliği: Yeşil Tedarik Zincirine Doğru

The aims of the study were (i) to determine amount of the vegetable losses and waste generated along the supply chain by production system such as under greenhouse and conventional system in open area, (ii) to explore the amount of willingness to pay for recycling vegetable losses and waste by composting and its determinants, (iii) to reveal the economic feasibility of composting vegetable losses and waste at district level and (iv) to calculate the individual and social cost of vegetable losses and waste along the supply chain by production system in Turkey. The farm level research data were collected from 81 conventional farms and 45 greenhouse farms in the Samsun province of Turkey by using questionnaires. In addition, 50 traders and 17 greengrocers, 13 supermarkets and 9 local marketers were interviewed. When quantifying vegetable losses and waste in mass, vegetable supply chain was examined in five different stages such as production, postharvest handling and storage, processing and packaging, distribution and retail. Contingent valuation method was used to asses willingness to pay of farmers, traders/merchants in wholesale market hall, greengrocer and super markets for composting of vegetable losses and waste. The economic feasibility of recycling of waste was revealed by using the net present value, cost-benefit analysis and internal rate of return. According to the research findings, the loss rates of vegetables produced per hectare in the greenhouse at the farm, wholesaler and retailer levels were respectively 2.2%; 1% and 20.3%. The loss rates of vegetables produced per hectare in the conventional farm at the farm, wholesaler and retailer levels were 3%, respectively; 0.9% and 16.8%. The individual loss of producers in the examined area was 0.67 thousand US $/year. The rates of individual loss of farms to annual agricultural income were 1.7% and 2.4% in greenhouse and conventional farms, respectively. Other individual losses in wholesales, retailer and consumers were 0.25, 4.89 and 1.02 thousand US $, respectively. The total social loss in the examined area was 6.83 thousand US $. When an assessment was made at the national level, the social loss was about 4% of the annual agricultural income. According to the research results, it has been concluded that depending on the amount of losses, the compost production facility to be established in the district can economically recycle vegetable losses and wastes.

P1190 Inflammatory Bowel Disease Treatment Economics: Assessing the Financial Ramifications and Striving for Healthcare Equity

Abstract Background Inflammatory Bowel Disease (IBD) has emerged as a public health challenge. In addition to the health effects on patients, IBD also carries a significant economic impact. The diagnosis, treatment, and follow-up of IBD entail considerable costs for both patients and the healthcare system. Therefore, understanding the economic impact of this disease is crucial for making informed decisions about its management and resource allocation. The aim of this study was to determine the short-term (one month) and long-term (twelve months) economic impact of medical care and surgical treatment in patients diagnosed with IBD at a tertiary-level hospital in Mexico. Methods A retrospective study was conducted, which included 118 patients diagnosed with IBD and treated at the IBD Clinic of the "Dr. Eduardo Liceaga" General Hospital in Mexico over the past 12 months. The economic impact of both medical treatment (conventional and biological) and surgical treatment in managing IBD was evaluated. For the calculation of medical treatment costs, the unit costs of medications were based on maximum retail prices at a conventional pharmacy. Surgical treatment costs were based on the hospital's provided costs. Individual costs for each patient were recorded and tabulated, and the total cost for each treatment regimen was calculated at one and twelve months. Descriptive statistical methods were used to analyze the data to obtain measures of central tendency and dispersion. Results The average monthly cost of medical treatment for a patient with IBD is estimated to be $11,612.45 Mexican pesos (MXN), resulting in a total cost of $139,349.40 MXN over 12 months. Considering all our patients, the total cost of medical care reaches $16,443,229.20 MXN in 12 months. Regarding surgical treatment, there is an average cost of $626,847.45 MXN per surgical event in patients with IBD. The total cost of surgical treatment for our IBD patients, encompassing a total of 24 patients, amounts to $15,043,379 MXN. Therefore, medical treatment appears to be more cost-effective compared to surgical treatment (the total cost of medical treatment for the 121 patients over one year is $16,443,229.20 MXN, while the total cost of surgical treatment for the 24 patients is $15,043,379 MXN). In our institution, 95% of the IBD Clinic patients receive free medical care. This represents significant cost savings for patients. Conclusion This study provides evidence regarding the economic impact of medical and surgical treatment in patients with IBD. The results support the consideration of medical treatment as the more cost-effective option while emphasizing the significance of free medical care in improving equitable access and alleviating the financial burden on patients and their families.

The secret lies in the approach: Confronting antigay and antilesbian prejudice while minimizing individual costs.

The secret lies in the approach: Confronting antigay and antilesbian prejudice while minimizing individual costs.

What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients' experiences and expectations.

Many patients with depressive disorders use antidepressants longer than clinically indicated. Long-term use of antidepressants is associated with high individual and societal costs. Patients often perceive antidepressant discontinuation as challenging. To understand patients' expectations about discontinuation, to document their experiences with long-term use and discontinuation, and to identify factors that can help or hinder discontinuation. Qualitative study using semi-structured interviews via telephone with adult patients in Germany. We interviewed 32 patients with remitted major depressive disorder and long-term antidepressant use. We analysed transcripts with content analysis aided by MAXQDA to derive thematic categories. Patients expected to eliminate side effects or regain independence after discontinuation. Such positive expectations were perceived as facilitators and motivated patients' wish to discontinue antidepressants. However, patients also had negative expectations such as recurrence or discontinuation symptoms. Patients' negative expectations were often fuelled by previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. Most patients perceived antidepressants as being effective, but experienced side effects and further problems. Patients felt inadequately informed about treatment duration and methods for discontinuation. Further barriers and facilitators included a stable environment, availability of support, and treatment information. Patients prefer to discontinue antidepressants within structured frameworks that provide information and support. Identified facilitators and barriers may help optimise appropriate use and discontinuation of antidepressants in routine practice. Promoting functional expectations and specifying individualised approaches to minimise dysfunctional expectations, adapted to patients' previous experiences, appear to be especially important.

The costs of chronic pain-Long-term estimates.

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain. The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence. In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss. Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain. This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.