Statistical Life Year Research Articles

Estimating the societal cost of heroin dependence in an Australian population engaged in treatment or harm reduction services

IntroductionHeroin dependence is a public health concern in Australia. High mortality rates, increased risk of physical/mental health comorbidities and increased risk of social issues contribute to a high personal and societal cost. The aim of this paper is to understand the societal cost of heroin dependence in an Australian population. MethodsA longitudinal cohort study of 600 people with heroin dependence were interviewed at five timepoints. Resource use was determined from interviews and was multiplied by unit costs to estimate the annual healthcare, productivity, crime and other costs (homelessness, heroin drug and prison costs). The monetary value of premature mortality was calculated using the value of a statistical life year method. ResultsThe annual mean societal cost of heroin dependence in Australia was A$120,599/person. This included healthcare costs (A$10,055), lost productivity costs (A$63,158), crime costs (A$7204) and other costs (A$40,182). Healthcare costs, lost productivity costs, crime costs and other costs trended downwards over the five waves. Lost productivity was the highest cost contributor (52 %), followed by heroin drug (25 %). The estimated number of life years lost due to heroin over the 11-year study period was 2703 years, which approximates to a monetary value of premature death of $213 million. Discussion and conclusionsThe significant societal cost emphasises the importance of providing resources to heroin dependence. The cost of lost productivity, crime and heroin contributed to over 80 % of the total costs, which highlights the illicit nature and reduced capacity to work contributes to the high costs to society.

A cost-benefit analysis of the life-prolonging effect of nonsteroidal anti-inflammatory drugs for persons with dementia and pain

ABSTRACT Persons with dementia are more susceptible to pain. If they take Nonsteroidal Anti-Inflammatory Drugs (NSAID) as pain relievers, the policy question is whether these medicines will be socially worthwhile. In this paper, a Cost-Benefit Analysis (CBA) was undertaken of the NSAID to see whether their benefits outweigh the costs for elderly persons with dementia. To construct the benefits, a Quality Adjusted Life Year was used as the intervention output, which was then converted into monetary terms using the Value of a Statistical Life Year. Using estimates based on a large, US national panel data set, the CBA found that the NSAID generated positive net-benefits. It was possible to re-evaluate all the prior dementia interventions that were based on the same data set, using the same methods as for the NSAID CBA. By comparing the NSAID results with those from the other alternative dementia interventions one can establish public funding priorities.

Evaluating Health and Well-Being Returns on Investment in a Cancer Biobank.

Objectives: To evaluate the population health returns from investment in the Victorian Cancer Biobank (VCB), a research consortium including five hospital-integrated sample repositories located in Melbourne, Australia. Methods: This economic evaluation assigned monetary values to the health gains attributable to VCB-supported research. These were then compared with the total investment in VCB infrastructure since inception (2006-2022) to determine the return on investment (ROI). A time lag of 40 years was incorporated, recognizing the delay from investment to impact in scientific research. Health gains were therefore measured for the years 2046-2066, with a 3% discount rate applied. Health gains were measured in terms of disability-adjusted life years (DALYs) attributable to VCB-associated research, with monetary cost assigned via the standardized value of a statistical life year (AU$227,000). The age-standardized DALY rate attributable to cancer was modeled for two standpoints (1) extrapolating the current decreasing trajectory and (2) assuming nil future improvement from current rates, with 33% of the difference attributed to scientific innovation. The proportion of the aggregate health gain attributable to VCB-supported research was estimated from the number of VCB-credited scientific publications as a proportion of total oncology publications over the same period. Results: The AU$32,628,016 of public funding invested in VCB activities over the years 2006-2022 is projected to generate AU$84,561,373 in total (discounted) savings. ROI was AU$1.59 for each AU$1 invested. Conclusions: The VCB offers a strong ROI in terms of impacts on health, justifying the expenditure of public funds and supporting the use of biobanks to advance scientific research.

Estimating the indirect economic burden of cancer in Jordan: a retrospective observational study

ObjectiveThe aim of this study is to estimate the indirect economic burden of 22 cancer types in Jordan using both the human capital approach (HCA) and the value of a...

The untapped health and climate potential of cycling in France: a national assessment from individual travel data

Promoting active modes of transportation such as cycling may generate important public health, economic, and climate mitigation benefits. We aim to assess the mortality and morbidity impacts of cycling in a country with relatively low levels of cycling, France, along with associated monetary benefits. We further assess the potential additional benefits of shifting a portion of short trips from cars to bikes, including projected greenhouse gas emissions savings. Using individual data from a nationally representative mobility survey, we described the French 2019 cycling levels by age and sex. We conducted a burden of disease analysis to assess the incidence of five chronic diseases (breast cancer, colon cancer, cardiovascular diseases, dementia, and type-2 diabetes) and the number of deaths prevented by cycling, based on national incidence and mortality data and dose-response relationships from meta-analyses. We assessed the corresponding direct medical cost savings and the intangible costs prevented based on the value of a statistical life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<5km) car trips to cycling. The French adult (20-89 years) population was estimated to cycle on average 1 min 17 sec pers-1 day-1 in 2019, with important heterogeneity across sex and age. This yielded benefits of 1,919 (uncertainty interval, UI: 1,101-2,736) premature deaths and 5,963 (UI: 3,178-8,749) chronic disease cases prevented, with males reaping nearly 75% of these benefits. Direct medical costs prevented were estimated at €191 million (UI: 98-285) annually, while the corresponding intangible costs were nearly 25 times higher (€4.8 billion, UI: 3.0-6.5). We estimated that on average, €1.02 (UI: 0.59-1.62) of intangible costs were prevented for every km cycled. Shifting 25% of short car trips to cycling would yield approximatively a 2-fold increase in deaths prevented, while also generating important CO2 emissions reductions (0.257 MtCO2e, UI: 0.231-0.288). In a country with a low- to moderate-cycling culture, cycling already generates important public health and health-related economic benefits. Further development of active transportation would increase these benefits while also contributing to climate change mitigation targets. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Value per Statistical Life at the Sub-National Level as a Tool for Assessing Public Health and Environmental Problems.

This article aims to estimate the Value per Statistical Life (VSL) and Value per Statistical Life Year (VSLY) at the sub-national level, which can be used to calculate the economic impact of health and environmental problems. We estimate the value of life for Mexico and its 32 states, grouped into 5 regions for 2021. We used the OECD's guidelines on "Mortality Risk Valuation in Environment, Health and Transport Policies," which applies the measure of Willingness to Pay (WTP) and Cost-Benefit Analysis (CBA). Mexico's overall VSL of $2 000 000 USD in 2021 showcases the value placed on human life. The variation in VSL across the 32 states, with Chiapas having the lowest VSL of $400 000 USD and Mexico City boasting the highest VSL of $3 300 000 USD highlights the different levels of regional development and people's willingness to pay to reduce the risk of mortality. Our estimates of VSL and VSLY have the potential to contribute to the evaluation of public policies in the fields of health and the environment. Monetizing human life through these estimates can offer valuable insights to policymakers at both the national and sub-national levels. By quantifying the economic value placed on human life, this paper helps decision-makers prioritize investments, assess the cost-effectiveness of interventions, and allocate resources to maximize societal well-being.

Economic burden of premature deaths attributable to different heatwaves in China: A multi-site study, 2014–2019

It has been well documented that heatwaves are linked to elevated mortality and morbidity. However, the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality, which can provide important insights for public health considerations. Hence, we used a two-stage time series analysis, combined with values of statistical life (VSL) based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions. We further conducted stratified analyses by age, sex, and region. We found 2.9% (95%CI: 0.0%, 6.5%)‒20.0% (95%CI: 2.9%, 34.2%) of VSL were attributable to heatwaves, corresponding to attributable economic losses (AELs) of 2.20 (95%CI: 0.32, 3.77)‒4.77 (95%CI: 1.53, 7.63) billion CNY. The economic burden of death was most sensitive to heatwave H99P_2D (99th percentile, at last 2 consecutive days), while H97·5P_2D (97.5th percentile, at last 2 consecutive days) caused the highest attributable economic losses. Females and elderly people aged ≥ 65 years were more sensitive. The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves, respectively. By contrast, the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves, respectively. The AELs were larger in urban areas than in rural areas. Tailored intervention strategies, primarily focusing on vulnerable populations and regions, should be formulated to reduce the economic loss due to heatwaves in the context of climate change.

Disease costs due to outdoor ambient particulate matter pollution in Germany, 2018

Abstract Introduction In addition to the population health effects of outdoor ambient particulate matter pollution (PM2.5), estimates of the costs related to these health impacts are increasingly requested to inform policy decision-making processes. Within the UKAGEP-project the burden of disease due to PM2.5 in Germany was monetized. Methods First, the disease burden attributable to PM2.5 in Germany for the year 2018 was estimated using the Environmental Burden of Disease approach. To estimate the monetary impact of PM2.5, two approaches were followed. We applied the Value of Statistical Life (VSL) approach, using a monetary value of about 6.3 (2.4-7.2) million € attached to each death case. Further, we used the Value Of a statistical Life Year (VOLY) approach, attaching a monetary value of 58,623 (36.646-146.582) € to the loss of a life year. Statistical uncertainties in both the disease burden results and the VSL and VOLY values were considered, presenting a lower and upper estimate of the overall disease costs. Results In 2018, the overall burden of disease attributable to PM2.5 was 209,702 (194,265-391,112) Disability-Adjusted Life Years. Using the VOLY-approach, this corresponds to disease costs of about 17 (7-57) billion €. In contrast, when using the VSL-approach, the estimated 15,652 (10,390-21,466) deaths attributable to PM2.5 in this year result in disease costs of about 98 (25-124) billion €. Conclusions In comparison with other cost assessments, connecting EBD estimates with the VSL- and VOLY-approach allows to include indirect and intangible costs and not to simply focus on the disease treatment costs. The VSL-approach leads to remarkably higher costs because it does not take into account the age at the time of death and thus attaches the same monetary value to each death case. We recommend to use the VOLY-approach because it considers the remaining life expectancy. Key messages • Air pollution causes considerable disease costs in Germany. • We recommend to use the VOLY-approach because it considers the remaining life expectancy.

Economic costs related to foodborne disease in Burkina Faso and Ethiopia in 2017

IntroductionFoodborne diseases (FBD) are a significant problem in low- and middle-income countries, especially in Africa. Country-specific estimates of the economic costs related to FBD caused by different hazards in different food products can inform decision makers about this problem’s magnitude. This aids policy makers in prioritising actions to mitigate risks and prevent illness. Although estimates exist for many high-income countries, they are lacking for African countries.MethodsThis study estimates economic cost in Burkina Faso and Ethiopia related to FBD caused by non-typhoidal Salmonella enterica (NTS), Campylobacter spp. (CAMP) and enterotoxigenic Escherichia coli (ETEC) in all foods, chicken meat and tomatoes. The World Health Organization’s estimates of FBD burden, updated from 2010 to 2017, were used as a basis. Economic cost estimates were the sum of estimates of willingness-to-pay (WTP) to reduce risk of death and of pain and suffering, and lost productivity. WTP was based on value of statistical life (VSL) and value of statistical life year (VSLY), extrapolated from USA data. We used sensitivity options to account for uncertainty in these values.ResultsMean economic costs related to FBD caused by NTS, CAMP and ETEC in 2017 were estimated at 391 million constant 2017 international dollars in Burkina Faso and 723 million in Ethiopia. These represent 3.0% of gross national income in Burkina Faso and 0.9% in Ethiopia. Lost productivity contributed 70%, WTP to reduce risk of death 30%, and WTP to reduce risk of pain and suffering 1-2%. NTS caused the highest costs, followed by ETEC and CAMP. Chicken meat caused 9-12 times higher costs than tomatoes. Children under five years (14.6-17.1% of populations) bore 20-75% of the costs. Due to uncertainty in disease burden and economic data, costs could be four times higher than mean estimates.DiscussionPolicies to control FBD likely result in substantial benefits, especially efforts aiming at this study’s hazards in chicken meat and children under 5 years. Efforts to reduce uncertainty in VSL, VSLY and disease burden estimates, estimate costs for other countries, attribute costs to other food products and hazards, further standardise estimation methodologies, and estimate treatment costs and illness prevention expenditures are recommended.

Estimating the economic impact of COVID-19 disruption on access to sexual and reproductive health and rights in Eastern and Southern Africa.

The Coronavirus disease 2019 (COVID-19) resulted in the disruption of Sexual and Reproductive Health Rights (SRHR) services in the Eastern and Southern Africa region. To date, studies estimating the impact of COVID-19 disruptions have mainly focused on SRHR services without estimating the economic implication. We used national service coverage data on the effectiveness of interventions from the lives saved tool (LiST), a mathematical modeling tool that estimates the effects of service coverage change in mortality. We computed years lost due to COVID-19 disruption on SRHR using life expectancy at birth, number of years of life lost due to child mortality, and life expectancy at average maternal death. We calculated the economic value of the lives saved, using the values of statistical life year for each of the countries, comparing 2019 (pre-COVID-19) to 2020 (COVID-19 era). The total life-years lost were 1,335,663, with 1,056,174 life-years lost attributed to child mortality and 279,249 linked to maternal mortalities, with high case-fatality rates in the Democratic Republic of Congo, Burundi, and Tanzania. The findings show COVID-19 disruptions on SRHR services between 2019 and 2020 resulted in US$ 3.6 billion losses, with the highest losses in Angola (USD 777 million), South Africa (USD 539 million), and Democratic Republic of Congo (USD 361 million). The monetized value of disability adjusted life years can be used as evidence for advocacy, increased investment, and appropriate mitigation strategies. Countries should strengthen their health systems functionality, incorporating and transforming lessons learned from shock events.

Monetary values of increasing life expectancy: Sensitivity to shifts of the survival curve.

Individuals' monetary values of decreases in mortality risk depend on the magnitude and timing of the risk reduction. We elicited stated preferences among three time paths of risk reduction yielding the same increase in life expectancy (decreasing risk for the next decade, subtracting a constant from or multiplying risk by a constant in all future years) and willingness to pay (WTP) for risk reductions differing in timing and life-expectancy gain. Respondents exhibited heterogeneous preferences over the alternative time paths, with almost 90 percent reporting transitive orderings. WTP is statistically significantly associated with life-expectancy gain (between about 7 and 28 days) and with respondents' stated preferences over the alternative time paths. Estimated value per statistical life year (VSLY) can differ by time path and averages about $500,000, roughly consistent with conventional estimates obtained by dividing estimated value per statistical life by discounted life expectancy.

Consistent valuation of a reduction in mortality risk using values per life, life year, and quality-adjusted life year.

The monetary value of a reduction in mortality risk can be accurately characterized using the alternative concepts of value per statistical life (VSL), value per statistical life year (VSLY), and value per quality-adjusted life year (VQALY). Typically, each of these values depends on the age and other characteristics of the affected individual; at most one of the values can be independent of age. The common practice of valuing a transient or persistent risk reduction using a constant VSL, VSLY, or VQALY yields systematic differences in the calculated monetary value that depend on the age at which the risk reduction begins, its duration, time path, and whether future lives, life years, or quality-adjusted life years are discounted. Mutually consistent, age-dependent VSL, VSLY, and VQALY are derived and the large differences in valuation of illustrative transient and persistent risk reductions that can result from assuming age-independent values of each of the three concepts are illustrated.

Investment case for primary health care in low- and middle-income countries: A case study of Kenya.

Primary healthcare (PHC) systems attain improved health outcomes and fairness and are affordable. However, the proportion of PHC spending to Total Current Health Expenditure in Kenya reduced from 63.4% in 2016/17 to 53.9% in 2020/21 while external funding reduced from 28.3% (Ksh 69.4 billion) to 23.9% (Ksh 68.2 billion) over the same period. This reduction in PHC spending negatively affects PHC performance and the overall health system goals. We conducted a cost-benefit analysis and computed costs against the economic benefits of a PHC scale-up. Activity-Based Costing (ABC) on the provider perspective was employed to estimate the incremental costs. The OneHealth Tool was used to estimate the health impact of operationalizing PHC over five years. Finally, we quantified Return on Investment (ROI) by estimating monetized DALYs based on a constant value per statistical life year (VSLY) derived from a VSL estimate. The total projected cost of PHC interventions in the Kenya was Ksh 1.65 trillion (USD 15,581.91 billion). Human resource was the main cost driver accounting for 75% of the total cost. PHC investments avert 64,430,316 Disability Adjusted Life-Years (DALYs) and generate cost savings of Ksh. 21.5 trillion (USD 204.4 Billion) over five years. Shifting services from high-level facilities to PHC facilities generates Ksh 198.2 billion (USD 1.9 billion) and yields a benefit-cost ratio of 16:1 in 5 years. Thus, every $1 invested in PHC interventions saves up to $16 in spending on conditions like stunting, NCDs, anaemia, TB, Malaria, and maternal and child health morbidity. Evidence of the economic benefits of continued prioritization of funding for PHC can strengthen the advocacy argument for increased domestic and external financing of PHC in Kenya. A well-resourced and functional PHC system translates to substantial health benefits with positive economic benefits. Therefore, governments and stakeholders should increase investments in PHC to accelerate economic growth.

Estimating mortality cost and social cost of CO2 emitted by items, applied to passenger vehicles

Over 60% of carbon emissions are from residential consumption. People in developed nations need to reduce their carbon footprints six-fold to stabilize CO2 levels in the atmosphere. This research develops a method of estimating and monetizing mortality costs of items. Mortality Cost of Carbon Rate (MCCR) is the fraction of a climate change related death that would probably occur over 80 yr with a specified temperature trajectory, from the emission of 1 tCO2e. MCCRs are allocated to items on an exponential curve generated from two researched MCCRs corresponding to temperature trajectories. MCC of an item (MCCI) is its MCCR multiplied by its life cycle CO2e emissions. The method was applied to the 2020 Australian passenger vehicle fleet and 6 vehicle types. MCCI was compared to mortalities from crashes and exhaust pollution. Total fleet mortality was estimated at around 62,000/ year. Mortality from 2020 CO2 emissions will probably be around 56,000 - 75 times higher than crash deaths - with uncertainty range 28,000 to 106,000, compared to toxic exhaust emissions 5,600 and crashes 750. A Sustainable Personal CO2 Footprint' of 1.5 t CO2/ person/ year was set as a benchmark for sustainable consumption. Electric buses, E-bicycles/ scooters and micro-EVs are sustainable and if universally adopted, would reduce mortality by 96%. Social Cost of Carbon Mortality Rate (SCCMR) monetizes MCCR using a global Value of a Statistical Life Year. SCCM of items (SCCMI) is calculated as for MCCI. Research estimates of MCCR and SCCMR vary according to assumed causes of mortality, temperature trajectories and discount rates; many are underestimated as they exclude some mortality damage sectors. Toxic exhaust emission and crash mortalities were monetized using the Australian Value of a Statistical Life. Total social mortality cost of a large 4 wd ICE diesel SUV was approximately $6300, current fleet average $4800, and micro-EV $400.

Sustainable Development Goal Halftime Project: Benefit-Cost Analysis Using Methods from the Decade of Vaccine Economics Model

AbstractIn 2023, the world will be at “halftime” with respect to the sustainable development goals (SDGs). This midline acts as an important milestone to review the progress of the SDGs and develop policies based on the most effective interventions. To estimate the remaining resources needed to achieve SDG targets for vaccines from 2023 to 2030 as well the resulting economic benefits, in this analysis, the incremental economic benefit-cost ratio (BCR) for immunization programs in 80 low- and middle-income countries targeted by the Global Vaccine Action Plan from 2023 to 2030 is calculated. Of these 80 countries, 27 are classified as low-income countries and 53 are classified as lower-middle-income countries (LMICs). The economic evaluation covers 9 vaccines employed against 10 antigens and delivered through both routine immunization programs and supplemental immunization activities. The vaccines covered in the analysis include pentavalent vaccine, human papillomavirus vaccine, Japanese encephalitis vaccine, measles vaccine, measles-rubella vaccine, meningococcal conjugate A vaccine, pneumococcal conjugate vaccine, rotavirus vaccine, and yellow fever vaccine, and correspond to the vaccines covered in the return-on-investment estimates presented in Sim et al., which covered 94 LMICs from 2011 to 2030. For these countries, we estimate program costs from the health system perspective, including vaccine costs such as costs to procure vaccines, which incorporate injection supplies and freight; and immunization delivery costs, which include nonvaccine commodity costs to deliver immunizations to target populations and incorporate labor, cold chain and storage, transportation, facilities, training, surveillance, and wastage. Economic benefits are calculated using a value of statistical life year (VSLY) approach applied to modeled cases, and deaths averted are converted into averted years of life lost using life expectancy data. BCRs are presented as the final output that compares incremental costs and benefits from the baseline of 2022 levels, assuming diminishing returns to scale. Overall, for this period, we estimate total costs of US$ 7,581,837,329.08 with VSLY benefits of US$ 762,172,371,553.54, resulting in a BCR of 100.53.

Exploring the Health and Economic Burden Among Truck Drivers in Australia: A Health Economic Modelling Study

Background The transport and logistics industry contributes to a significant proportion of the Australian economy. However, few studies have explored the economic and clinical burden attributed to poor truck driver health. We therefore estimated the work-related mortality burden among truck drivers over a 10-year period. Methods Dynamic life table modelling was used to simulate the follow-up of the Australian male working-age population (aged 15–65 years) over a 10-year period of follow-up (2021–2030). The model estimated the number of deaths occurring among the Australian working population, as well as deaths occurring for male truck drivers. Data from the Driving Health study and other published sources were used to inform work-related mortality and associated productivity loss, hospitalisations and medication costs, patient utilities and the value of statistical life year (VoSLY). All outcomes were discounted by 5% per annum. Results Over 10 years, poor truck driver health was associated with a loss of 21,173 years of life lived (discounted), or 18,294 QALYs (discounted). Healthcare costs amounted to AU$485 million (discounted) over this period. From a broader, societal perspective, a total cost of AU$2.6 billion (discounted) in lost productivity and AU$4.7 billion in lost years of life was estimated over a 10-year period. Scenario analyses supported the robustness of our findings. Conclusions The health and economic consequences of poor driver health are significant, and highlight the need for interventions to reduce the burden of work-related injury or disease for truck drivers and other transport workers.

Intensive care unit resources and patient-centred outcomes in severe COVID-19: a prospective single-centre economic evaluation.

SummaryDuring the COVID‐19 pandemic, ICU bed shortages sparked a discussion about resource allocation. We aimed to analyse the value of ICU treatment of COVID‐19 from a patient‐centred health economic perspective. We prospectively included 49 patients with severe COVID‐19 and calculated direct medical treatment costs. Quality of life was converted into aggregated quality‐adjusted life years using the statistical remaining life expectancy. Costs for non‐treatment as the comparator were estimated using the value of statistical life year approach. We used multivariable linear or logistic regression to identify predictors of treatment costs, quality of life and survival. Mean (SD) direct medical treatment costs were higher in patients in ICU with COVID‐19 compared with those without (£60,866 (£42,533) vs. £8282 (£14,870), respectively; p < 0.001). This was not solely attributable to prolonged ICU length of stay, as costs per day were also higher (£3115 (£1374) vs. £1490 (£713), respectively; p < 0.001), independent of overall disease severity. We observed a beneficial cost‐utility value of £7511 per quality‐adjusted life‐year gained, even with a more pessimistic assumption towards the remaining life expectancy. Extracorporeal membrane oxygenation therapy provided no additional quality‐adjusted life‐year benefit. Compared with non‐treatment (costs per lost life year, £106,085), ICU treatment (costs per quality‐adjusted life‐year, £7511) was economically preferable, even with a pessimistic interpretation of patient preferences for survival (sensitivity analysis of the value of statistical life year, £48,848). Length of ICU stay was a positive and extracorporeal membrane oxygenation a negative predictor for quality of life, whereas costs per day were a positive predictor for mortality. These data suggest that despite high costs, ICU treatment for severe COVID‐19 may be cost‐effective for quality‐adjusted life‐years gained.

Global and regional projections of the economic burden of Alzheimer's disease and related dementias from 2019 to 2050: A value of statistical life approach.

SummaryBackgroundThe burden of Alzheimer's disease and related dementias (ADRDs) is expected to grow rapidly with population aging, especially in low- and middle-income countries, in the next few decades. We used a willingness-to-pay approach to project the global, regional, and national economic burden of ADRDs from 2019 to 2050 under status quo.MethodsWe projected age group and country-specific disability-adjusted life years (DALYs) lost to ADRDs in future years based on historical growth in disease burden and available population projections. We used country-specific extrapolations of the value of a statistical life (VSL) year and its future projections based on historical income growth to estimate the economic burden – measured in terms of the value of lost DALYs – of ADRDs. A probabilistic uncertainty analysis was used to calculate point estimates and 95% uncertainty bounds of the economic burden.FindingsIn 2019, the global VSL-based economic burden of ADRDs was an estimated $2.8 trillion. The burden was projected to increase to $4.7 trillion (95% uncertainty bound: $4 trillion–$5.5 trillion) in 2030, $8.5 trillion ($6.8 trillion–$10.8 trillion) in 2040, and $16.9 trillion ($11.3 trillion–$27.3 trillion) in 2050. Low- and middle-income countries (LMICs) would account for 65% of the global VSL-based economic burden in 2050, as compared with only 18% in 2019. Within LMICs, upper-middle income countries would carry the largest VSL-based economic burden by 2050 (92% of LMICs burden and 60% of global burden).InterpretationADRDs have a large and inequitable projected future VSL-based economic burden.FundingThe Davos Alzheimer's Collaborative.

Human and Economic Cost of Disease Burden Due to Congenital Hypothyroidism in India: Too Little, but Not Too Late.

BackgroundCongenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation. Implementing newborn screening (NBS) in >52 countries enabled early detection and to initiate treatment of neonates with CH. India is yet to implement a national NBS program even though an estimated 5–15% of sick newborns suffer from genetic and metabolic disorders. Recent pilot studies confirm that the CH incidence rates range from 1 in 500 to 1 in 3,400 live births. Our objective was to estimate overall incidence rates of congenital hypothyroidism and to evaluate the costs and benefits of implementing universal NBS for CH in India.MethodsWe used the best available epidemiological and cost data to synthesize incidence rates and screening costs for CH in India. We conducted a meta-analysis of country-specific published literature and included 14 studies to calculate baseline CH incidence rates. We used two models to estimate intellectual disability in unscreened cohorts. Disability-adjusted life years (DALY) were calculated to quantify burden of disease utilizing disability weights. Direct costs including screening, confirmatory tests, and treatment costs were obtained from public and private market sources. Economic benefits were calculated from lost DALY using human capital approach and value of statistical life methods, utilizing gross national income (GNI) per capita data and value of statistical life year (VSLY), respectively. Cost discounting was used to estimate the present value of future benefits over lifetime of affected newborns.ResultsThe incidence rate of CH in India is 72 (95% CI: 58, 85) cases per 100,000 live births. Based on this data, 1 in 1,388 (95% CI: 1166, 1714) infants were diagnosed with CH in India for the year 2018. The estimated annual incidence ranged from 14,000 to 20,730 cases, and those at risk for intellectual disability ranged from 5,397 to 13,929 cases. Estimated discounted and undiscounted lost DALYs were 57,640 and 410,000, respectively. Direct annual costs for universal screening for CH in India is around USD187 million. Based on current incidence and expected severity of sequelae, economic losses ranged from USD 159 million to 1.1 billion. Benefit–cost ratios ranged from 1.8 to 6.ConclusionsUniversal NBS for CH is one of the healthcare interventions that is beneficial to prevent morbidity and cost saving. The cumulative economic benefits, derived from prevention of intellectual disability, assuming cost effectiveness threshold of three times of gross domestic product per capita, far outweigh the direct and indirect costs of screening, treatment, and surveillance throughout the life of the affected individuals. Our analysis strongly supports the argument for investing in NBS that provides good value for money and would yield substantial financial gains for the country.

The benefits of not living in a nursing home

ABSTRACT We identify and value four categories of benefits of not living in a nursing home (NH). The four categories relate to the two components of a Quality Adjusted Life Year (QALY), which is the outcome effect for this evaluation. For each QALY component, the quality of a life year foregone and the loss of a life, NHs have a direct effect and an indirect effect as NHs increase dementia symptoms. Estimates of the QALY components are obtained from two fixed effects regression equations applied to a large national data set with quality of life and dementia symptoms as dependent variables. Valuation of the QALY effects is based on the value of a statistical life year literature. Because every category of QALY effect produces negative benefits, a fifth category of foregone benefits is the savings from not incurring expenses for a NH. The total losses are large, equal to $1.93 trillion.