Economic analysis of banana peel and sweet potato vines in diets for rabbits

This study aimed to evaluate the costs of using banana peel (BP) and sweet potato vine (SPV) in rabbit diets. BP and SPV were chosen to replace maize and alfalfa hay, because, in addition to the ingredients having similar nutritional characteristics, they are among the most expensive ingredients in rabbit diets. Data were obtained through a biological assay carried out in the Cuniculture Laboratory of the Universidade Federal de Santa Maria, Santa Maria, RS, Brazil. Fifty New Zealand white rabbits, weaned at 35 days of age, were fed during the growth phase (35 to 84 days) with increasing levels of BP and SPV, replacing maize and alfalfa hay (T0, T25, T50, T75 and T100% replacement). A diet containing 100% replacement (T100) had the lowest cost per kilogram, which was R$ 1.18/kg, while the controlled diet was 57% more expensive, costing R$ 2.08/kg. The total operating cost to produce a rabbit with control treatment was R$10.93/head and at T100, it was R$6.51/head. The animal income for a live rabbit was R$ 24.08 and R$ 23.95 in treatments T0 and T100, respectively. Regarding the gain margin per animal (GMA), in TO it was R$ 13.16 while in T100 it was R$ 17.44, therefore the GMA was 32.55% higher when using the T100 diet. In conclusion, it is more economical and feasible to feed rabbits with diets containing 100% BP and SPV, replacing maize and alfalfa hay.

Health and economic burden of wildland fires PM2.5-related pollution in Portugal - A longitudinal study

Portugal has been affected by wildland fires that destroy thousands of hectares of forest, causing damage to the environment and to the exposed populations. This study aims to assess the influence of wildland fire emissions on air quality, its effect on population health and the related costs, between 2015 and 2018 in Portugal. The cause-specific mortality due to PM2.5 was calculated considering the exposure for five endpoints in adults, twelve age groups for adults and considering children under five years old. The contribution of wildfire emissions to PM2.5 concentrations in Portugal was assessed through EMEP-MSC/W model. Results showed that the average annual fire emissions of PM2.5, CO, CH4, CO2 and NO2 a significant and continuous increase was observed during the first three years (2015, 2016 and 2017) for all pollutants, followed by a decrease in 2018, with values lower than those observed in 2015. Regarding the long-term exposure to PM2.5 emitted by fires a total of 32, 93, 189 and 31 deaths, corresponding to a cost of 59, 174, 360 and 60 million EUR in 2015, 2016, 2017 and 2018, respectively, were estimated. On the other hand, in the first three years an increase in years of life lost (YLL) values of 496, 1608 and 3092 was observed, corresponding to a cost of 16, 54 and 105 million EUR, respectively, followed by a decrease in 2018 with a YLL of 480, corresponding to a cost of 17 M€.

A Retrospective Observational Real-Word Analysis of the Adherence, Healthcare Resource Consumption and Costs in Patients Treated with Bisoprolol/Perindopril as Single-Pill or Free Combination

INTRODUCTION

The present real-world analysis aims to compare the drug utilization, hospitalizations and direct healthcare costs related to the use of single-pill combination (SPC) or free-equivalent combination (FEC) of perindopril and bisoprolol (PER/BIS) in a large Italian population.

METHODS

This observational retrospective analysis was based on administrative databases covering approximately 7 million subjects across Italy. All adult subjects receiving PER/BIS as SPC or FEC between January 2017-June 2020 were included. Subjects were followed for 1 year after the first prescription of PER/BIS as FEC (± 1 month) or SPC. Before comparing the SPC and FEC cohorts, propensity score matching (PSM) was applied to balance the baseline characteristics. Drug utilization was investigated as adherence (defined by the proportion of days covered, PDC) and persistence (evaluated by Kaplan-Meier curves). Hospitalizations and mean annual direct healthcare costs (due to drug prescriptions, hospitalizations and use of outpatient services) were analyzed during follow-up.

RESULTS

The original cohort included 11,440 and 6521 patients taking the SPC and FEC PER/BIS combination, respectively. After PSM, two balanced SPC and FEC cohorts of 4688 patients were obtained (mean age 70 years, approximately 50% male, 24% in secondary prevention). The proportion of adherent patients (PDC ≥ 80%) was higher for those on SPC (45.5%) than those on FEC (38.6%), p < 0.001. The PER/BIS combination was discontinued by 35.8% of patients in the SPC cohort and 41.7% in the FEC cohort (p < 0.001). The SPC cohort had fewer cardiovascular (CV) hospitalizations (5.3%) than the free-combination cohort (7.4%), p < 0.001. Mean annual total healthcare costs were lower in the SPC (1999€) than in the FEC (2359€) cohort (p < 0.001).

CONCLUSION

In a real-world setting, patients treated with PER/BIS SPC showed higher adherence, lower risk of drug discontinuation, reduced risk of CV hospitalization, and lower healthcare costs than those on FEC of the same drugs.

Economic Burden of Clostridioides difficile Infection in European Countries

Clostridioides difficile infection (CDI) remains a considerable challenge to healthcare systems worldwide. Although CDI represents a significant burden on healthcare systems in Europe, few studies have attempted to estimate the consumption of resources associated with CDI in Europe. The reported extra costs attributable to CDI vary widely according to the definitions, design, and methodologies used, making comparisons difficult to perform. In this chapter, the economic burden of healthcare facility-associated CDI in Europe will be assessed, as will other less explored areas such as the economic burden of recurrent CDI, community-acquired CDI, pediatric CDI, and CDI in outbreaks.

The economic burden of mental disorders: results from the Netherlands mental health survey and incidence study-2

OBJECTIVE

Currently, there is a paucity of up-to-date estimates of the economic burden caused by mental disorders. Such information could provide vital insight into one of the most serious and costly-yet to some extent preventable-health challenges facing the world today.

METHOD

Data from a national psychiatric-epidemiological cohort study (NEMESIS-2, N = 6506) were used to provide reliable, relevant, and up-to-date cost estimates (in 2019 Euro) regarding healthcare costs, productivity losses, and patient and family costs associated with DSM-IV mental disorders both at individual level, but also in the general population and in the workforce of the Netherlands (per 1 million population).

RESULTS

In the general population, the costs of mood disorders, specifically depression, are substantial and rank above those from the anxiety disorders, whilst costs of anxiety disorders are more substantial than those stemming from substance use disorders, even when the per-person costs of drug abuse appear highest of all. In the workforce, specific and social phobias are leading causes of excess costs. The workforce has lower healthcare costs but higher productivity costs than general population.

DISCUSSION

The findings suggest that (preventive) healthcare interventions targeting the workforce are likely to become cost-effective and underscore the importance for employers to create healthy work environments. Overall, the results highlight the need to strengthen the role of mental health promotion and prevention of mental disorders in the social domain before people require treatment to reduce the staggering and costly burden caused by mental disorders to individuals and society.

Economic costs of family caregiving for persons with advanced stage cancer: a longitudinal cohort study

PURPOSE

To form a multifaceted picture of family caregiver economic costs in advanced cancer.

METHODS

A multi-site cohort study collected prospective longitudinal data from caregivers of patients with advanced solid tumor cancers. Caregiver survey and out-of-pocket (OOP) receipt data were collected biweekly in-person for up to 24 weeks. Economic cost measures attributed to caregiving were as follows: amount of OOP costs, debt accrual, perceived economic situation, and working for pay. Descriptive analysis illustrates economic outcomes over time. Generalized linear mixed effects models asses the association of objective burden and economic outcomes, controlling for subjective burden and other factors. Objective burden is number of activities and instrumental activities of daily living (ADL/IADL) tasks, all caregiving tasks, and amount of time spent caregiving over 24 h.

RESULTS

One hundred ninety-eight caregivers, 41% identifying as Black, were followed for a mean period of 16 weeks. Median 2-week out-of-pocket costs were $111. One-third of caregivers incurred debt to care for the patient and 24% reported being in an adverse economic situation. Whereas 49.5% reported working at study visit 1, 28.6% of caregivers at the last study visit reported working. In adjusted analysis, a higher number of caregiving tasks overall and ADL/IADL tasks specifically were associated with lower out-of-pocket expenses, a lower likelihood of working, and a higher likelihood of incurring debt and reporting an adverse economic situation.

CONCLUSIONS

Most caregivers of cancer patients with advanced stage disease experienced direct and indirect economic costs.

IMPLICATIONS FOR CANCER SURVIVORS

Results support the need to find solutions to lessen economic costs for caregivers of persons with advanced cancer.

Economic impacts associated with the health effects of climate change in South America: a scoping review

This scoping review assesses the current evidence on the health impacts of climate change and associated economic costs in South America. In total, 3281 studies were identified using a systematic search strategy, but only 23 articles met the inclusion criteria and were analysed. The results from these articles indicate that the health effects of climate change will likely be costly for South America; however, evidence is limited to a handful of countries or regional analyses that ignore heterogeneity across and within countries. Most of the analysed studies looking at extreme weather events related to climate change focus on the effects and costs of droughts and fire events. A broader understanding of the topic could be achieved by estimating other extreme weather events' health effects and costs, using appropriate research methods to identify causal impacts, and including a more comprehensive and representative regional population sample. Beyond identifying effects, it is important to investigate demand responses for healthcare services, associated costs, availability and expansion of infrastructure, and cost-effectiveness of policies aimed at coping with and adapting to the health dimension of climate change.

Economic costs for outpatient treatment of eating disorders in Japan

BACKGROUND

Few studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan.

METHOD

A multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3 months. Multivariate linear regression models were performed to adjust for covariates.

RESULTS

This study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670 yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient = - 23.86; 95% confidence interval = - 32.09 to - 15.63; P < 0.001). In contrast, EDE-Q global scores and BMI at 3 months were not significantly different between these departments.

CONCLUSIONS

This study clarifies the economic costs of treating outpatients with eating disorders in Japan. The medical reimbursement points per interview minute were lower in Psychosomatic Medicine departments than in Psychiatry departments, while there were no apparent differences in the treatment outcomes. Addressing this issue is necessary to provide an adequate healthcare system for patients with eating disorders in Japan.

Influence of stigma, sociodemographic and clinical characteristics on mental health-related service use and associated costs among young people in the United Kingdom

This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9-17 years and their caregivers, we assessed 407 young people's use of services due to mental health problems, young people's psychopathology, demographic characteristics, maternal education and caregivers' stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use - persistent psychopathology and socioeconomic disadvantage increased, and caregivers' intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.

Association between non-pharmacological therapy and healthcare use and expenditure of patients with diabetes mellitus

This study explored the sociodemographic and clinical characteristics of patients with diabetes who incorporated two non-pharmacological therapies into their lifestyle and the association between non-pharmacological therapy and healthcare utilization and expenditure. In the USA, 26.4 million people were reportedly diagnosed with diabetes and treated with diet modification or physical activity in the 2019 Medical Expenditure Panel Survey. Physical activity was defined as moderate-to-vigorous physical exercise five times per week, whereas dietary modification involved healthy eating that reduced glucose levels. Only 4.8 million patients with diabetes did not integrate any non-pharmacological intervention into their therapy regimen. Those who did not include non-pharmacological interventions had higher annual total healthcare expenditures (M = $18,428) than those who incorporated either single (M = $17,058) or dual intervention (M = $15,134). A significant difference was observed in prescribed medicine utilization per year for those who did not include lifestyle modifications or non-pharmacological interventions. Propensity score-matched participants revealed significant differences in hospital stays, outpatient visits, and emergency department expenditures. Patients with diabetes who adhered to two non-pharmacological interventions showed significantly lower healthcare utilization. Being active and following a healthy diet can help prevent the progression of diabetes mellitus complications and reduce the cost associated with diabetes.

What are economic costs and when should they be used in health economic studies?

Economic analyses of healthcare interventions are an important consideration in evidence-based policymaking. A key component of such analyses is the costs of interventions, for which most are familiar with using budgets and expenditures. However, economic theory states that the true value of a good/service is the value of the next best alternative forgone as a result of using the resource and therefore observed prices or charges do not necessarily reflect the true economic value of resources. To address this, economic costs are a fundamental concept within (health) economics. Crucially, they are intended to reflect the resources' opportunity costs (the forgone opportunity to use those resources for another purpose) and they are based on the value of the resource's next-best alternative use that has been forgone. This is a broader conceptualization of a resource's value than its financial cost and recognizes that resources can have a value that may not be fully captured by their market price and that by using a resource it makes it unavailable for productive use elsewhere. Importantly, economic costs are preferred over financial costs for any health economic analyses aimed at informing decisions regarding the optimum allocation of the limited/competing resources available for healthcare (such as health economic evaluations), and they are also important when considering the replicability and sustainability of healthcare interventions. However, despite this, economic costs and the reasons why they are used is an area that can be misunderstood by professionals without an economic background. In this paper, we outline to a broader audience the principles behind economic costs and when and why they should be used within health economic analyses. We highlight that the difference between financial and economic costs and what adjustments are needed within cost calculations will be influenced by the context of the study, the perspective, and the objective.

Valuing preventable deaths from major non-communicable diseases and all causes associated with sedentary behavior in Argentina

OBJECTIVE

This study estimated the population attributable fractions, preventable deaths, and indirect economic costs from major non-communicable diseases (NCDs) and all causes associated with excessive sitting time in Argentina in 2019.

METHODS

Population attributable fractions were used to calculate preventable deaths from NCDs and all causes associated with prolonged sitting time (≥6 h/d). Then, the human capital approach was used to quantify the present value of lifetime earnings, which was subsequently used to calculate indirect costs due to lost productivity. A Monte Carlo simulation was performed in three counterfactual scenarios to evaluate the sensitivity of the results.

RESULTS

In Argentinian men and women, respectively, approximately 11.3% (381) [10% (290)] of deaths from colon cancer, 4.4% (250) from breast cancer (women only), 4.6% (588) [4.4% (402)] from coronary heart disease, 30.5% (1390) [27% (1047)] from diabetes, and 14.9% (24,686) [13.7% (21,418)] from all causes could have been avoided annually by eliminating excessive sitting time. The indirect economic costs of excessive sitting time reached 0.025% (0.019%-0.032%) and 0.37% (0.25-0.58%) of gross domestic product (GDP) for major NCDs and all causes, respectively. High levels of heterogeneity were found at the regional level.

CONCLUSION

Prolonged sitting time generates substantial societal costs. Public policies aimed at reducing excessive sedentary behavior in the overall population, especially in the most affected regions, would represent considerable savings for society as a whole. Such initiatives should address the complex and multifactorial causes of sedentary behavior, the clear gender and age differences in this behavior, and the factors underlying these differences.

The economic impact of the introduction of universal rotavirus vaccination on rotavirus gastroenteritis related hospitalisations in children in Ireland

BACKGROUND

Rotavirus gastroenteritis (RVGE), a vaccine preventable disease, remains a common cause of severe gastroenteritis in children globally. Ireland introduced the universal rotavirus vaccination to the national immunisation programme in 2016. In this paper the economic impact on RVGE related hospitalisations amongst children under 5 years is examined.

METHODS

Using national data from all Irish public hospitals, an Interrupted Times Series Analysis (ITSA) compares RVGE hospitalisations amongst children under 5 years, pre- and post-vaccine introduction. Costs are estimated and ITSA results are compared to the counterfactual to estimate the economic impact of the vaccine. A probit model examines patient characteristics pre- and post-vaccine introduction.

RESULTS

Vaccine introduction coincided with lowered RVGE related hospitalisations. While this effect was delayed (1 year) there is evidence of a sustained impact. RVGE patients' post-vaccine introduction were likely to be over 2 years (p = 0.001) and length of stay was lower on average (p = 0.095). The counterfactual analysis revealed 492 RVGE hospitalisations were avoided on average annually since the introduction of the vaccine. This has an estimated economic value of €0.92 million per annum.

CONCLUSIONS

Following the introduction of the rotavirus vaccine in Ireland, hospitalisations for RVGE decreased significantly and those hospitalised were older and with a reduced length of stay on average. This has the potential for significant cost savings for the Irish healthcare system.

Economic costs and cost-effectiveness of conditional cash transfers for the uptake of services for the prevention of vertical HIV transmissions in a resource-limited setting

BACKGROUND

Prevention of mother-to-child transmission (PMTCT) is critical for halting the HIV epidemic. However, innovative approaches to improve PMTCT uptake may be resource-intensive. We examined the economic costs and cost-effectiveness of conditional cash transfers (CCTs) for the uptake of PMTCT services in the Democratic Republic of Congo.

METHODS

We leveraged data from a randomized controlled trial of CCTs (n = 216) versus standard PMTCT care alone (standard of care (SOC), n = 217). Economic cost data came from multiple sources, with costs analyzed from the societal perspective and reported in 2016 international dollars (I$). Effectiveness outcomes included PMTCT uptake (i.e., accepting all PMTCT visits and services) and retention (i.e., in HIV care at six weeks post-partum). Generalized estimating equations estimated effectiveness (relative risk) and incremental costs, with incremental effectiveness reported as the number of women needing CCTs for an additional PMTCT uptake or retention. We evaluated the cost-effectiveness of the CCTs at various levels of willingness-to-pay and assessed uncertainty using deterministic sensitivity analysis and cost-effectiveness acceptability curves.

RESULTS

Mean costs per participant were I$516 (CCTs) and I$431 (SOC), representing an incremental cost of I$85 (95% CI: 59, 111). PMTCT uptake was more likely for CCTs vs SOC (68% vs 53%, p < 0.05), with seven women needing CCTs for each additional PMTCT service uptake; twelve women needed CCTs for an additional PMTCT retention. The incremental cost-effectiveness of CCTs vs SOC was I$595 (95% CI: I$550, I$638) for PMTCT uptake and I$1028 (95% CI: I$931, I$1125) for PMTCT retention. CCTs would be an efficient use of resources if society's willingness-to-pay for an additional woman who takes up PMTCT services is at least I$640. In the worst-case scenario, the findings remained relatively robust.

CONCLUSIONS

Given the relatively low cost of the CCTs, policies supporting CCTs may decrease onward HIV transmission and expedite progress toward ending the epidemic.

Economic costs, health-related quality of life outcomes and cost-utility of a physical and psychological group intervention targeted at older adults with neurogenic claudication

BACKGROUND

Emerging evidence suggests that structured and progressive exercise underpinned by a cognitive behavioural approach can improve functional outcomes in patients with neurogenic claudication (NC). However, evidence surrounding its economic benefits is lacking.

OBJECTIVES

To estimate the economic costs, health-related quality of life outcomes and cost-effectiveness of a physical and psychological group intervention (BOOST programme) versus best practice advice (BPA) in older adults with NC.

METHODS

An economic evaluation was conducted based on data from a pragmatic, multicentre, superiority, randomised controlled trial. The base-case economic evaluation took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2018-2019 prices) were collected prospectively over a 12 month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of the BOOST programme in comparison to BPA. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.

RESULTS

Participants (N = 435) were randomised to the BOOST programme (n = 292) or BPA (n = 143). Mean (standard error [SE]) NHS and PSS costs over 12 months were £1,974 (£118) in the BOOST arm versus £1,827 (£169) in the BPA arm (p = 0.474). Mean (SE) QALY estimates were 0.620 (0.009) versus 0.599 (0.006), respectively (p = 0.093). The probability that the BOOST programme is cost-effective ranged between 67 and 83% (NHS and PSS perspective) and 79-89% (societal perspective) at cost-effectiveness thresholds between £15,000 and £30,000 per QALY gained. INMBs ranged between £145 and £464 at similar cost-effectiveness thresholds. The cost-effectiveness results remained robust to sensitivity analyses.

CONCLUSIONS

The BOOST programme resulted in modest QALY gains over the 12 month follow-up period. Future studies with longer intervention and follow-up periods are needed to address uncertainty around the health-related quality of life impacts and cost-effectiveness of such programmes. Trial registration This study has been registered in the International Standard Randomised Controlled Trial Number registry, reference number ISRCTN12698674. Registered on 10 November 2015.

Misleading estimates of economic impacts of biological invasions: Including the costs but not the benefits

The economic costs of non-indigenous species (NIS) are a key factor for the allocation of efforts and resources to eradicate or control baneful invasions. Their assessments are challenging, but most suffer from major flaws. Among the most important are the following: (1) the inclusion of actual damage costs together with various ancillary expenditures which may or may not be indicative of the real economic damage due to NIS; (2) the inclusion of the costs of unnecessary or counterproductive control initiatives; (3) the inclusion of controversial NIS-related costs whose economic impacts are questionable; (4) the assessment of the negative impacts only, ignoring the positive ones that most NIS have on the economy, either directly or through their ecosystem services. Such estimates necessarily arrive at negative and often highly inflated values, do not reflect the net damage and economic losses due to NIS, and can significantly misguide management and resource allocation decisions. We recommend an approach based on holistic costs and benefits that are assessed using likely scenarios and their counter-factual.

Leveraging Systematic Reviews to Explore Disease Burden and Costs of Per- and Polyfluoroalkyl Substance Exposures in the United States

Accelerating evidence confirms the contribution of per- and polyfluoroalkyl substances (PFAS) to disease burden and disability across the lifespan. Given that policy makers raise the high cost of remediation and of substituting PFAS with safer alternatives in consumer products as barriers to confronting adverse health outcomes associated with PFAS exposure, it is important to document the costs of inaction even in the presence of uncertainty. We therefore quantified disease burdens and related economic costs due to legacy PFAS exposures in the US in 2018. We leveraged systematic reviews and used meta-analytic inputs whenever possible, identified previously published exposure-response relationships, and calculated PFOA- and PFOS-attributable increases in 13 conditions. These increments were then applied to census data to determine total annual PFOA- and PFOS-attributable cases of disease, from which we calculated economic costs due to medical care and lost productivity using previously published cost-of-illness data. We identified PFAS-attributable disease costs in the US of $5.52 billion across five primary disease endpoints shown to be associated with PFAS exposure in meta-analyses. This estimate represented the lower bound, with sensitivity analyses revealing as much as $62.6 billion in overall costs. While further work is needed to assess probability of causation and establish with greater certainty effects of the broader category of PFAS, the results confirm further that public health and policy interventions are still necessary to reduce exposure to PFOA and PFOS and their endocrine-disrupting effects. This study demonstrates the large potential economic implications of regulatory inaction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12403-022-00496-y.

China's roadmap to plastic waste management and associated economic costs

Plastic is one commonly used polymer material to support our daily lives. However, once the plastic waste enters the environment, it slowly degrades, which causes long-term and deep ecological environmental problems. As the world's largest plastic producer and consumer, China generated around 26.74 million tons of plastic waste in 2019, and has made ambitious policies to cope with the plastic waste issues. This study predicts the generation trends and management costs of plastic waste in China from 2020 to 2035 under three different scenarios (Business as usual-BAU, Current policy scenario -CPS, and Target policy scenario-TPS), in which China is divided into three regions for specific policy implications. In addition, the scenario analysis and Monte Carlo simulations are used to obtain confidence interval of assessments. The results show that the plastic waste emission will be 34.82 million tons under BAU, 13.49 million tons under CPS and 2.63 million tons under TPS in 2035, respectively, and there will be significant changes in regional contributions in plastic waste emission (e.g., Eastern region: 45.7% to 9.7%; Central region:25.2% to 30.9%; Western region: 29.1% to 59.4% from 2019 to 2035 under TPS). In addition, the environmental and economic benefits increase with the rigor of plastic waste management policy as there will generate a net income of US$3.01 billion under TPS compared to the cost of US$ 2.61 billion under BAU and US$120 million under CPS. In view of this, it is vital that China develop appropriate plastic management policies based on the status of various regions, attempt to achieve economic development while reducing plastic waste emissions, and finally achieving a "win-win" situation of economy and environment.

Welfare consequences of early-onset Borderline Personality Disorder: a nationwide register-based case-control study

Information regarding welfare consequences of early onset of Borderline Personality Disorder (BPD) is limited. This nationwide study aimed to estimate the educational and employment outcome and health care costs of patients with early-onset BPD compared with matched controls. All patients (< 19 years) with first diagnosis of BPD in the Danish Patient Register (NPR) during the period 1983-2015 were included. Health care costs and socioeconomic variables were extracted from national registers. A total of 171 patients was compared with 677 controls. At the age of 20 years, BPD patients had reached a statistically significantly lower educational level (including lower primary school grades) and employment status compared with the controls. When adjusting for the parents' educational level, BPD patients were nearly 22 times more likely to be unemployed (OR = 21.7, 95% CI 11.9, 39.6), and nearly 15 times more likely to be on disability pension (OR = 14.8, 95% CI 5.0, 43.9) than controls. Furthermore, the total health care costs were more than 8 times higher in the BPD group. Early onset of BPD was associated with lower educational and vocational outcome and increased health care costs as early as at the age of 20 years. Even after controlling for parents' lower socioeconomic status, the patients have poorer outcome than the control group. This underlines that initiatives to support patients in finishing school and secondary education is highly needed. Future prevention and early intervention programs should target patients with early-onset BPD and their families.

A Scoping Review of the Economic Burden of Non-Cancerous Genitourinary Conditions

OBJECTIVE

To provide a scoping review of the economic burden of non-cancerous genitourinary conditions (NCGUCs).

METHODS

A scoping review of the literature surrounding the economic costs associated with NCGUCs was conducted for literature published between 1990-2020. The articles were screened and relevant articles were selected for review. These articles were abstracted with information pertaining to the costs surrounding NCGUCs. A descriptive analysis of the data was conducted.

RESULTS

We found 3298 articles in our scoping review. Of these, we found 38 relevant articles related to pelvic floor dysfunction and pelvic organ prolapse, interstitial cystitis, neurogenic bladder, nocturia, urinary tract infections, urolithiasis, urinary incontinence, benign prostatic hyperplasia, overactive bladder, and erectile dysfunction of which the data is reviewed.

CONCLUSION

Although the data in estimating the economic burden is limited, existing evidence demonstrates a significant component of health care spending on NCGUCs. Much of the spending is out-of-pocket and indirect costs that are difficult to measure which may increase the magnitude of the costs. There is a need for future research that takes a holistic look at the economic impact of NCGUCs.

Willingness to bear economic costs of measures against SARS-CoV-2 in Germany

Background

The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2.

Methods

Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21–22 April 2020, N = 976; wave 16: 7–8 July 2020, N = 977; wave 38: 9–10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19.

Results

65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves.

Conclusions

The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11734-4.

The distribution of work-related musculoskeletal disorders among nurses in sub-Saharan Africa: a scoping review protocol

BACKGROUND

Although measures have been put in place, musculoskeletal injuries are noticeable high among the nursing fraternity with low back pain (LBP) being the most prevalent. It is evident that healthcare professionals are in constant exposure to occupational hazards such as musculoskeletal injuries as they discharge their professional duties. Not only does LBP affect the health of the nurses, it also creates a huge burden on the health systems with consequent poor performance at the workplace as well as economic burden. Therefore, the main objective of this study is to map evidence on the prevalence, incidence, mortality, risk factors, and economic costs of musculoskeletal disorders (MSD) in sub-Saharan Africa (SSA). This is a scoping review because we want to map the evidence of MSD among nurses in SSA and to identify the scope of body literature in which the findings will be used for planning the intervention study thereafter.

METHODS AND ANALYSIS

Scoping review will be done to explore, describe, and map literature on the prevalence, incidence, mortality, risk factors, and economic costs related to MSD among nurses in SSA. The search will be done using databases such as PubMed, EBSCOHOST, Scopus, Web of Science, Science direct, Sabinet, WorldCat Local (iCatalogue), MEDLINE, CINAHL, Google Scholar, nursing academic editions, and World Health Organization (WHO) library databases. The search will look for primary studies within peer-reviewed articles as well as gray literature. In addition, the researcher will search for articles using keywords from the included studies as well as the list of references for related studies. The screening will be guided by Arksey and O'Malley's framework which has five steps to be followed: (I) identifying the research question, (II) identifying relevant studies, (III) study selection, (IV) charting the data, and (V) collating, summarizing, and reporting the results, and the scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A thematic content analysis will be used to give the narrative account of the review; using NVivo version 11 software, two independent reviewers will follow the three stages outlined by the thematic synthesis theory: (a) coding the findings of the included studies line-by-line, (b) organizing these free codes into related areas to construct descriptive themes, and (c) developing analytical themes. The outcome of coding will be verified and discussed with a third reviewer. The process of cross-checking the outcomes of coding of each included article will be discussed thoroughly.

DISCUSSION

At the end, this study anticipates to uncover the relevant literature in SSA in regard to the prevalence, incidence, mortality, risk factors, and economic costs related to MSD among nurses; furthermore, findings from this study will help in identifying research gaps; informing policy, priority in funding, and planning; and guiding future research.

Measles outbreak investigation process in low- and middle-income countries: a systematic review of the methods and costs of contact tracing

Aim

The occurrence of measles outbreaks has increased, and previously measles-free countries are experiencing a resurgence, making measles elimination by 2020 unlikely. Therefore, outbreak prevention and rapid response strategies will need to be intensified. This systematic review therefore examines whether contact tracing (CT) as compared to no CT is an effective means of reducing measles spread during outbreaks in low- and middle-income countries (LMICs).

Subject and methods

A systematic review was conducted by searching six databases (CINAHL, Global Health, Medline, Cochrane Library, Web of Science and PubMed). The 17 included articles were appraised using the Critical Appraisal Skills Programme checklists and analysed using a narrative synthesis.

Results

CT is often used alongside mass communication strategies and hospital record checks. Interviewing measles cases to identify contacts, and considering everyone who has shared a space with a case as a contact are common CT methods. Also, CT can be done backwards and/or forwards with the measles case as the focal point of the investigation process. The cost per case of an outbreak response dominated by CT is high especially in terms of labour for the health sector and productivity losses for households. However, overall outbreak expenditure can be low if CT results in fewer and less severe measles cases and a short outbreak duration.

Conclusion

CT data as a standalone and comparative active surveillance approach in LMICs is scarce. If CT is initiated early, it can prevent large outbreaks, thereby reducing the economic burden of measles and drive LMICs towards measles elimination.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-021-01590-2.

Preterm birth lifetime costs in the United States in 2016: An update

The societal cost of preterm birth indicates potential economic gains from interventions that reduce the incidence of preterm birth. Changes in the epidemiology of preterm birth and healthcare costs require periodic updates to cost estimates. Previously reported incremental cost estimates for the United States in 2004 were updated. The discounted present value of the excess cost associated with prematurity for the 2016 US birth cohort was estimated to be $25.2 billion: $17.1 billion for medical care of persons born preterm, $2.0 billion for delivery care, $1.3 billion for early intervention and special education, and $4.8 billion in lost productivity due to associated disabilities in adults. The nominal and inflation-adjusted incremental costs per preterm birth increased by 26% and 4%, respectively, during 2004-2016. The aggregate cost decreased by 4%, associated with declines in overall births and the preterm birth rate and changes in the distribution by gestational age.

Influence of Osteoporosis Following Spine Surgery on Reoperation, Readmission, and Economic Costs: An 8-Year Nationwide Population-Based Study in Korea

OBJECTIVE

To evaluate the relationship between prevalence of osteoporosis and risk factors, medical costs, reoperation, and readmission in patients after spine surgery.

METHODS

Patients >50 years old with thoracic or lumbar spine diseases who underwent spine surgery between 2005 and 2008 were selected from the Korean National Health Insurance Service databases for analysis. There were 147,676 patients selected, who were divided into 2 groups (osteoporosis and non-osteoporosis) and followed for 8 years. Multiple logistic regressions were performed to examine the effect of osteoporosis following spine surgery.

RESULTS

Patients with osteoporosis showed significant increases in readmission rates (odds ratio = 1.26, P < 0.001). Osteoporosis was found to be significantly associated with longer hospital stays and increased medical costs regardless of the cause of spine disease. For readmission, there was a 62-day difference in hospitalization time and U.S. dollars $2040 difference in medical costs between the osteoporosis group and non-osteoporosis group. Total medical costs of the osteoporosis group were about U.S. dollars $310 million more than total medical costs of the non-osteoporosis group. Osteoporosis increased the risk of reoperation in fusion surgery, particularly in the first 3 months postoperatively (odds ratio = 1.34, P < 0.001).

CONCLUSIONS

Osteoporosis was significantly associated with higher readmission rates, longer hospitalization, and greater medical costs during the 8-year follow-up. It also increased the risk of reoperation in fusion surgery. Proper management of osteoporosis is essential before spine surgery, particularly fusion surgery, to help reduce patients' socioeconomic burden and produce more satisfactory surgical outcomes.

Understanding the economic impact of myalgic encephalomyelitis/chronic fatigue syndrome in Ireland: a qualitative study

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling and complex chronic disease of unknown origin, whose symptoms, severity, and progression are extremely variable. Despite being relatively common, the condition is poorly understood and routine diagnostic tests and biomarkers are unavailable. There is no evidence on the economic impact of ME/CFS in Ireland. Methods: Adopting a patient and public involvement approach, we undertook three semi-structured focus groups, which together included 15 ME/CFS patients and 6 informal carers, to consider costs related to ME/CFS in Ireland, including how and why they arise. Focus groups were audio-recorded and transcribed verbatim, and we employed thematic analysis following the approach set out in Braun and Clarke (2006).   Results: Themes from the data were: (1) Healthcare barriers and costs; (2) Socioeconomic costs; (3) Costs of disability; and, (4) Carer-related costs. Patient participants described a range of barriers to effective healthcare that led to extra costs, including delays getting a diagnosis, poor awareness/understanding of the condition by healthcare professionals, and a lack of effective treatments. These were linked to poor prognosis of the illness by participants who, as a result, faced a range of indirect costs, including poorer labour market and education outcomes, and lower economic well-being. Direct extra costs of disability were also described, often due to difficulties accessing appropriate services and supports. Informal carer participants described a range of impacts, including time costs, burnout, and impacts on work and study. Conclusions: The data suggests that ME/CFS patients face a wide range of costs, while there are also wider societal costs in the form of costs to the health service, lost productivity, and impacts on informal carers. These results will inform ongoing research that aims to quantify the economic burden of ME/CFS in Ireland and raise awareness of the illness amongst healthcare providers and policymakers.

The value of lost productivity from workplace bullying in Ireland

BACKGROUND

Workplace bullying is a pervasive problem with significant personal, social and economic costs. Estimates of the resulting lost productivity provide an important societal perspective on the impact of the problem. Understanding where these economic costs fall is relevant for policy.

AIMS

We estimated the value of lost productivity to the economy from workplace bullying in the public and private sectors in Ireland.

METHODS

We used nationally representative survey data and multivariable negative binomial regression to estimate the independent effect of workplace bullying on days absent from work. We applied the human capital approach to derive an estimate of the annual value of lost productivity due to bullying by sector and overall, in 2017.

RESULTS

Bullying was independently associated with an extra 1.00 (95% CI: 0.38-1.62) days absent from work over a 4-week period. This differed for public and private sector employees: 0.69 (95% CI: -0.12 to 1.50) versus 1.45 (95% CI: 0.50-2.40) days respectively. Applying official data, we estimated the associated annual value of lost productivity to be €51.8 million in the public sector, €187.6 million in the private sector and €239.3 million overall.

CONCLUSIONS

The economic value of lost productivity from workplace bullying in Ireland is significant. Although bullying is more prevalent in the public sector, it has a larger effect on absence in the private sector. Given this, along with the greater overall share of employees, productivity losses from bullying are considerably larger in the private sector in Ireland.

Initial assessment of the economic burden of major parasitic helminth infections to the ruminant livestock industry in Europe

We report a European wide assessment of the economic burden of gastrointestinal nematodes, Fasciola hepatica (common liver fluke) and Dictyocaulus viviparus (bovine lungworm) infections to the ruminant livestock industry. The economic impact of these parasitic helminth infections was estimated by a deterministic spreadsheet model as a function of the proportion of the ruminant population exposed to grazing, the infection frequency and intensity, the effect of the infection on animal productivity and mortality and anthelmintic treatment costs. In addition, we estimated the costs of anthelmintic resistant nematode infections and collected information on public research budgets addressing helminth infections in ruminant livestock. The epidemiologic and economic input data were collected from international databases and via expert opinion of the Working Group members of the European Co-operation in Science and Technology (COST) action COMbatting Anthelmintic Resistance in ruminants (COMBAR). In order to reflect the effects of uncertainty in the input data, low and high cost estimates were obtained by varying uncertain input data arbitrarily in both directions by 20 %. The combined annual cost [low estimate-high estimate] of the three helminth infections in 18 participating countries was estimated at € 1.8 billion [€ 1.0-2.7 billion]. Eighty-one percent of this cost was due to lost production and 19 % was attributed to treatment costs. The cost of gastrointestinal nematode infections with resistance against macrocyclic lactones was estimated to be € 38 million [€ 11-87 million] annually. The annual estimated costs of helminth infections per sector were € 941 million [€ 488 - 1442 million] in dairy cattle, € 423 million [€ 205-663 million] in beef cattle, € 151million [€ 90-213 million] in dairy sheep, € 206 million [€ 132-248 million] in meat sheep and € 86 million [€ 67-107 million] in dairy goats. Important data gaps were present in all phases of the calculations which lead to large uncertainties around the estimates. Accessibility of more granular animal population datasets at EU level, deeper knowledge of the effects of infection on production, levels of infection and livestock grazing exposure across Europe would make the largest contribution to improved burden assessments. The known current public investment in research on helminth control was 0.15 % of the estimated annual costs for the considered parasitic diseases. Our data suggest that the costs of enzootic helminth infections which usually occur at high prevalence annually in ruminants, are similar or higher than reported costs of epizootic diseases. Our data can support decision making in research and policy to mitigate the negative impacts of helminth infections and anthelmintic resistance in Europe, and provide a baseline against which to measure future changes.

Estimating the total economic costs of Neospora caninum infections in dairy cows in Turkey

The aim of this study was to estimate the total cost of Neospora caninum infection in cows in Turkey. According to present literature, the mean seroprevalence of infection was estimated as 14.7%. The seropositivity rate of N. caninum in aborted cows was found to be 18%. The financial costs were estimated in US$ at 2019 prices. The total cost of N. caninum infection was estimated at US$710 (438-1043) per a dairy cow and the annual economic costs were estimated at US$40.5 (24.6-60.3) million for Turkey. In this study, the distribution of economic costs caused by neosporosis per cow was determined to be 67.3% for abortion, 16.8% prolonged calving interval, 4.6% milk loss, 3.5% additional artificial insemination, and 7.7% veterinary and diagnostic costs, respectively. All studies that have been conducted so far on Neosporosis are focused on the prevalence and the diagnosis of the disease in Turkey. In this study, we firstly determined the economic costs due to N. caninum infections and try to attract attention on the economic impacts of the disease. As a result, awareness among breeders regarding the epidemiology, control, and eradication of neosporosis should be raised through training activities; coordination between the relevant institutions and organizations should be ensured; emergency action plans should be prepared; and further spread of the disease should be prevented.

Quantifying the economic cost of antibiotic resistance and the impact of related interventions: rapid methodological review, conceptual framework and recommendations for future studies

BACKGROUND

Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR.

METHODS

A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review.

RESULTS

The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor.

CONCLUSIONS

Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.

Economic impact of heart failure with preserved ejection fraction: insights from the ALDO-DHF trial

Aims

Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear.

Therefore, we assessed the health care‐related costs of ambulatory HFpEF patients and the effect of spironolactone.

Methods and results

The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double‐blind, placebo‐controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction.

Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow‐up. We used a single‐patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities.

The average annual costs per patient in this cohort came up to €1, 118 (±2,475), and the median costs were €332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO₂max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs.

Conclusions

In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system.

Economic costs and benefits in diverse settings

Congenital toxoplasmosis (CT), the result of a primary infection of pregnant women with Toxoplasma gondii which was transmitted to the fetus, may result in mild to deep injuries occurring in the newborn or later in its development or in adolescence. The visual and cognitive impairment that can result imposes substantial economic costs on the individual and society. Numerous observational studies favor the conclusion that, with preventive measures currently available, it is possible to reduce the incidence of infections in pregnant women, the incidence of fetal infection by preventing transplacental transmission, and the gravity of injury in infected newborns. Treatment of infected newborns can also reduce the severity of consequences and the frequency of their occurrence later in life. Prevention programs, however, are applied in only a few countries; in most countries implementation of a national prevention program has not been considered or has been thought to be too expensive. This article lists the methods of prevention of CT and describes existing national prevention programs in France and Austria. It analyzes the economic costs and benefits of maternal screening for CT prevention and mitigation for society and for health systems. The economic feasibility of implementing national screening in low-prevalence, high-cost countries is illustrated with the example of the United States. New diagnostic tools are discussed and the implication of lower costs is considered, for countries with well-established screening programs as well as those with inadequate prenatal care networks.

Which decreases in air pollution should be targeted to bring health and economic benefits and improve environmental justice?

BACKGROUND

Fine particulate matter (PM_2.5) exposure entails large health effects in many urban areas. Public measures aiming at decreasing air pollution are often designed without targeting an explicit health benefit. Our objective was to investigate the health and economic benefits and the social inequalities in exposure resulting from several scenarios of reduction of PM_2.5 exposure, in order to support decisions about urban policies.

MATERIAL AND METHODS

In the French conurbations of Grenoble and Lyon (0.4 and 1.4 million inhabitants, respectively), PM_2.5 yearly average exposure was estimated on a 10-m grid by coupling a PM_2.5 dispersion model to population density. Changes in death cases, life expectancy, lung cancer and term low birth weight incident cases as well as associated health economic costs were estimated for ten PM_2.5 reduction scenarios differing in terms of amplitude of reduction and spatial extent. Changes in social differences in PM_2.5 exposure were also assessed.

RESULTS

During the 2015-2017 period, PM_2.5 average exposure was 13.9 μg/m³ in Grenoble and 15.3 μg/m³ in Lyon conurbations. Exposure to PM_2.5 led to an estimated 145 (95% Confidence Interval, CI, 90-199) and 531 (95% CI, 330-729) premature deaths, 16 (95% CI, 8-24) and 65 (95% CI, 30-96) incident lung cancers, and 49 (95% CI, 19-76) and 193 (95% CI, 76-295) term low birth weight cases each year in Grenoble and Lyon conurbations, respectively, compared to a situation without PM_2.5 anthropogenic sources, i.e. a PM_2.5 concentration of 4.9 μg/m³. The associated costs amounted to 495 (Grenoble) and 1767 (Lyon) M€/year for the intangible costs related to all-cause non-accidental mortality and 27 and 105 M€ for the tangible and intangible costs induced by lung cancer. A PM_2.5 exposure reduction down to the WHO air quality guideline (10 μg/m³) would reduce anthropogenic PM_2.5-attributable mortality by half while decreases by 2.9 μg/m³ (Grenoble) and 3.3 μg/m³ (Lyon) were required to reduce it by a third. Scenarios focusing only on the most exposed areas had little overall impact. Scenarios seeking to reach a homogeneous exposure in the whole study area were the most efficient in alleviating social inequalities in exposure.

CONCLUSIONS

Reduction scenarios targeting only air pollution hotspots had little expected impact on population health. We provided estimates of the PM_2.5 change required to reduce PM_2.5-attributable mortality by one third or more. Our approach can help targeting air pollution reduction scenarios expected to entail significant benefits, and it could easily be transposed to other urban areas.

Household economic costs associated with mental, neurological and substance use disorders: a cross-sectional survey in six low- and middle-income countries

BACKGROUND

Little is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.

AIMS

To assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.

METHOD

We conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).

RESULTS

Despite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.

CONCLUSIONS

Households living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.

DECLARATION OF INTEREST

D.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

Racial/ethnic disparities in disease burden and costs related to exposure to endocrine-disrupting chemicals in the United States: an exploratory analysis

OBJECTIVE

Studies have documented disparities in exposure to endocrine-disrupting chemicals (EDC), but no studies have investigated potential implications for racial/ethnic disparities in chronic disease and associated costs. Our objective was to examine EDC levels in the US population according to race/ethnicity and to quantify disease burden and associated costs.

STUDY DESIGN AND SETTING

EDC exposure levels in 2007-2010 were obtained from the National Health and Nutrition Examination Surveys. The associated disease burden and costs for 12 exposure-response relationships were determined for non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, Other Hispanics, and Other/Multicultural.

RESULTS

EDC exposure levels and associated burden of disease and costs were higher in non-Hispanic Blacks ($56.8 billion; 16.5% of total costs) and Mexican Americans ($50.1 billion; 14.6%) compared with their proportion of the total population (12.6% and 13.5%, respectively). Associated costs among non-Hispanic whites comprised 52.3% of total costs ($179.8 billion) although they comprise 66.1% of the US population. These disparities are driven by generally higher exposure to persistent pesticides and flame retardants among non-Hispanic blacks and Mexican Americans.

CONCLUSION

Our estimates suggest that racial/ethnic disparities in chronic diseases in the US may be because of chemical exposures and are an important tool to inform policies that address such disparities.

Systematic approach to evaluating environmental and ecological technologies for wastewater treatment

Evaluating the performance of wastewater treatment represents a challenging and complex task as it usually involves engineering, environmental and economic (3E) factors. In this study, we developed an 3E triangle model to evaluate the performance of environmental technologies (i.e., anaerobic-anoxic-oxic reactors, oxidation ditches, and membrane bioreactors) and ecological technologies (i.e., stabilization ponds, constructed wetlands, and slow-rate systems) for wastewater treatment. A total of 17 key performance indicators, such as energy consumption, pollutant removal, global warming potential and wastewater treatment fees, were considered in the 3E triangle model. The results indicated that, in terms of engineering performance, both the membrane bioreactors and constructed wetlands were stable, effective and reliable during their operating periods. When the environmental impacts of wastewater treatment technologies were compared via a life cycle assessment, the ecological technologies showed superior performance, in terms of environmental impacts, especially for the global warming potential and eutrophication potential. In general, environmental technologies exhibited higher treatment fees and unit construction costs because of their large power consumption and equipment costs. In contrast, ecological technologies had higher unit land use due to their large area requirements and low treatment capacity. In overall, both the membrane bioreactors and constructed wetlands showed excellent overall performance in the 3E triangle model. Wastewater treatment plant are typical case studies for addressing the interactions of water and energy elements. Reducing energy consumption is a hotspot for the research field of membrane bioreactors, while constructed wetlands are continually improved and optimized to have broad applications for rural wastewater treatment.

Economic Burden of Clostridium difficile Infection in European Countries

Clostridium difficile infection (CDI) remains a considerable challenge to health care systems worldwide. Although CDI represents a significant burden on healthcare systems in Europe, few studies have attempted to estimate the consumption of resources associated with CDI in Europe. The reported extra costs attributable to CDI vary widely according to the definitions, design, and methodologies used, making comparisons difficult to perform. In this chapter, the economic burden of healthcare facility-associated CDI in Europe will be assessed, as will other less explored areas such as the economic burden of recurrent CDI, community-acquired CDI, pediatric CDI, and CDI in outbreaks.

Hallucinations as a presenting complaint in emergency departments: Prevalence, diagnosis, and costs

Hallucinations occur in the context of many disorders. When experienced as distressing, they are a likely cause of presentation to emergency departments. Knowledge about the rates, diagnoses, and associated costs of hallucinations in emergency departments however is currently lacking. In this study, we analysed patients' presenting complaints in Western Australia's Emergency Department Data Collection dataset during a two year period (n = 1,798,754). Visits to emergency departments because of distressing hallucinations were more common than previously assumed. Hallucinations (auditory, visual, undifferentiated modality) accounted for 1.8% of all mental health-related presentations and 0.09% of all general health presentations (84.7 per 100,000 persons). Psychotic disorders accounted for a third of all presentations, and hallucinations without a clear medical or psychiatric cause represented 17% of the sample. Hallucination presentations had significantly prolonged lengths of stay compared to other mental health presentations (15 vs 7.5h, p < 0.001) and were linked to frequent re-admissions (average of 7.4 visits per year). Cost estimates revealed that hallucinations were in the top-10 most costly mental health complaint, and twice as costly to treat as delusions. Altogether, the service utilisation and care needs of people with distressing hallucinations outside of mental health services appear much larger than usually estimated.

Estimated economic costs of coal workers' pneumoconiosis among coal workers redeployed from the Fuxin mining group in China

Our research estimated the economic costs of possible cases of coal workers' pneumoconiosis (CWP) among redeployed coal workers from the Fuxin Mining Industry Group. The study cohort included 19,116 coal workers between 1965 and 2012. We estimated direct and indirect economic costs due to possible current and future CWP cases among redeployed coal workers. We found as of 2012 that 141 possible CWP cases might have resulted in economic costs of $37.52 million ($33.84 million were direct and $3.68 million indirect). Moreover, 221 possible future CWP cases would result in economic costs of $63.89 million ($57.20 million direct and $6.69 million indirect). Neither the Fuxin Mining Industry Group nor Fuxin could cover the costs of CWP screening and diagnosis, or social security payments for redeployed coal workers. We suggest that China's national government help Liaoning Province and Fuxin focus on health care and social security.

A soil biotechnology system for wastewater treatment: technical, hygiene, environmental LCA and economic aspects

Soil biotechnology (SBT) is a green engineering approach for wastewater treatment and recycling. Five SBT units located in the Mumbai region were under consideration of which holistic assessment of two SBT plants was carried out considering its technical, environmental and economic aspects and was compared with published research of other three. LCA has been done to evaluate the environmental impacts of construction and operation phase of SBT. Chemical oxygen demand (COD) and biochemical oxygen demand (BOD) removal of more than 90% can be achieved using this technology. Also, the nutrient removal proficiency (nitrate, nitrite, ammoniacal nitrogen, TKN, total nitrogen and phosphates) of this technique is good. On the other hand, SBT has low annual operation and maintenance cost, comparable to land-based systems and lower than conventional or advanced technologies. From the life cycle impact assessment, the main contributors for overall impact from the plant were identified as electricity consumption, discharges of COD, P-PO₄^3- and N-NH₄⁺ and disposal of sludge. The construction phase was found to have significantly more impact than the operation phase of the plant. This study suggests plant I is not relatively as efficient enough regarding sanitation. SBT provides several benefits over other conventional technologies for wastewater treatment. It is based on a bio-conversion process and is practically maintenance free. It does not produce any odorous bio-sludge and consumes the least energy.

A health intervention or a kitchen appliance? Household costs and benefits of a cleaner burning biomass-fuelled cookstove in Malawi

Pneumonia is the leading cause of mortality for children under five years in sub-Saharan Africa. Household air pollution has been found to increase risk of pneumonia, especially due to exposure from dirty burning biomass fuels. It has been suggested that advanced stoves, which burn fuel more efficiently and reduce smoke emissions, may help to reduce household air pollution in poor, rural settings.

This qualitative study aims to provide an insight into the household costs and perceived benefits from use of the stove in Malawi. It was conducted alongside The Cooking and Pneumonia Study (CAPS), the largest village cluster-level randomised controlled trial of an advanced combustion cookstove intervention to prevent pneumonia in children under five to date. In 2015, using 100 semi-structured interviews this study assessed household time use and perceptions of the stove from both control and intervention participants taking part in the CAPS trial in Chilumba. Household direct and indirect costs associated with the intervention were calculated.

Users overwhelming liked using the stove. The main reported benefits were reduced cooking times and reduced fuel consumption. In most interviews, the health benefits were not initially identified as advantages of the stove, although when prompted, respondents stated that reduced smoke emissions contributed to a reduction in respiratory symptoms. The cost of the stove was much higher than most respondents said they would be willing to pay.

The stoves were not primarily seen as health products. Perceptions of limited impact on health was subsequently supported by the CAPS trial data which showed no significant effect on pneumonia. While the findings are encouraging from the perspective of acceptability, without innovative financing mechanisms, general uptake and sustained use of the stove may not be possible in this setting. The findings also raise the question of whether the stoves should be marketed and championed as ‘health interventions’.

•

The first evaluation of household perceptions of an advanced cookstove trial in Malawi.

•

We investigate the intensive margin, i.e. how the technology is used and perceived.

•

Significant benefits from reduced cooking and fuel collection times were reported.

•

Unless prompted, respondents rarely associated the stoves with health benefits.

•

The high cost of the advanced cookstove will need addressing to ensure future uptake.

Costs of integrating cervical cancer screening at an HIV clinic in Kenya

OBJECTIVE

To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya.

METHODS

A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18 years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening.

RESULTS

There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening).

CONCLUSIONS

Integrating cervical cancer screening into HIV clinics would be cost-saving from a societal perspective compared with non-integrated screening. These findings could be used in cost-effectiveness analyses to assess incremental costs per clinical outcome in an integrated setting.

The Economic Burden of Post-prandial Hyperglycemia (PPH) Among People with Type 1 and Type 2 Diabetes in Three Countries

INTRODUCTION

Post-prandial hyperglycemia (PPH) among people with diabetes is a well-known clinical challenge to diabetes management. While the economic burden of diabetes is well studied, little is known about economic costs specific to PPH. The purpose of this study was to investigate costs of PPH related to work, diabetes management, and use of healthcare resources among people with diabetes taking bolus insulin.

METHODS

Data were collected in a web survey of 906 adults with type 1 (39%) and type 2 (61%) diabetes taking bolus insulin in Germany (34%), the UK (26%), and the USA (40%).

RESULTS

Sixty-two percent of respondents experienced PPH in the past week, and respondents averaged 1.7 episodes per week. Working respondents indicated that PPH affected their work productivity: 27% missed work time and 71% experienced work productivity issues while at work due to a recent episode of PPH. In terms of diabetes management, respondents with PPH in the past week measured their blood glucose (BG) more frequently than those without PPH (3.7 vs. 2.5 times/day, P < 0.001). PPH was also significantly associated with greater use of healthcare resources. Compared to those without PPH, respondents with PPH reported greater contact with healthcare professionals related to diabetes in the past year (5.5 vs. 4.4 visits, P < 0.001; 2.7 vs. 1.4 calls/emails, P < 0.001) and were more likely to report medical complications related to diabetes (72% vs. 55%, P < 0.001). Average annual costs associated with PPH due to missed work time, additional BG test strips, and physician visits were estimated to be $1239 USD per employed person in the USA.

CONCLUSION

Results indicate that PPH is associated with greater economic costs and that reducing the incidence of PPH would help mitigate such costs. Additional research is needed to better understand costs associated with PPH that may be more difficult to measure, as well as more long-term impacts and costs.

FUNDING

Novo Nordisk.

Estimating the costs of cervical cancer screening in high-burden Sub-Saharan African countries

OBJECTIVE

To estimate the capital investment and recurrent costs of national cervical cancer screening and precancer treatment programs in 23 high-incidence countries in Sub-Saharan Africa in order to provide estimates of the investment required to tackle the burden of cervical cancer in this region. These 23 countries account for 64% of the annual cervical cancer deaths in this region.

METHODS

Secondary data were used to estimate the financial costs of equipment purchases and economic costs of screening and treating eligible women over a 10-year period. Screening would be by visual inspection with acetic acid and treatment by cryotherapy or loop electrosurgical excision procedure.

RESULTS

Approximately US $59 million would be required to purchase treatment equipment if cryotherapy were placed at every screening facility. Approximately 20 million women would be screened over 10 years. Cost per woman screened in a screen-and-treat program was either US $3.33 or US $7.31, and cost per woman treated was either US $38 or US $71 depending on the location of cryotherapy equipment.

CONCLUSION

It would take less than US $10 per woman screened to significantly decrease the cervical cancer deaths that will occur in Sub-Saharan Africa over the next 10 years.

An estimate of the monthly cost of two major mental disorders in an Indian metropolis

BACKGROUND

THE COMPONENTS OF HIGH COST OF TREATING A CHRONIC PSYCHIATRIC ILLNESS ARE: long-term continuous treatment consisting of consultation and medication costs, traveling to the treatment centre and taking time off from work for both patient and caregiver. Apart from direct treatment costs, expenditure of time in care-giving results in indirect costs. All these costs are borne by families as the sufferer may be unable to work.

AIM

To estimate the cost of treatment of chronically ill patients at home, in terms of the above parameters.

METHODS

The sample consisted of 117 subjects of either sex in the age range of 18 to 60 years, ill for at least one year, diagnosed as schizophrenia (n=95) or bipolar disorder (n=22, a comparison group) who agreed to participate in the study along with at least one caregiver. The tools used were the Diagnostic Interview of Genetic Studies and Economic Burden Questionnaire administered to both the subject and the caregiver.

RESULTS AND CONCLUSIONS

The costs of treatment were found to be high but with wide variations in the range. Costs for bipolar disorder were somewhat higher than those for schizophrenia at least for the period of study. Demographic differences between subjects and caregivers were present.