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Health Economic Aspects of Injury Prevention at the Municipal Level
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
2014 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Unintentional injuries are a global health problem, which in 1996 was estimated to cause up to 3 million deaths per year. In Sweden, about 4,600 people die annually due to external causes of morbidity and mortality (injuries and poisoning). Among children 1 to 17 years old, injuries are the leading cause of death in Sweden for both boys and girls. Injuries are also the leading cause of life years lost before age 65 in men and the second most common in women.

Injury prevention interventions and programs can be implemented to mitigate the magnitude of this public health problem, the number of injuries in society, and the substantial costs associated with injuries. Society's resources are however limited and therefore it is pivotal that interventions are cost-effective and not only effective: that is, that they provide good value for money.

Hence, the aim of this thesis was to develop new knowledge and improve decision making by elaborating on some of the important health economic aspects of injury prevention. Consequently, a critical appraisal of the existing cost-effectiveness studies on injury prevention interventions and estimations of the societal costs for different types of injuries that needed medical attention were conducted. The critical appraisal of studies was limited to those studies that investigated interventions that could be implemented by municipalities. The results shows that injuries are associated with substantial societal costs but differ considerably between different types of injuries. The average cost per injury was estimated at € 2,726 and varied between € 892 and € 15,537. Furthermore, the results indicate that there are injury prevention interventions that offer good use of societal resources. However, there is  a general lack of economic evidence surrounding injury prevention interventions.

This thesis has expanded the knowledge in some important health economic aspects of injury prevention. The generated knowledge may advantageously be used in future research, including cost-effectiveness analyses of injury prevention interventions, and assist in the targeting of new research. Future research should focus on estimating the cost-effectiveness of different interventions and the reductions in quality of life due to different injuries. Costeffectiveness data help decision-makers make judiciously resource allocation decisions that maximise health gain given limited budgets.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. , 64 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 128
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-106227DOI: 10.3384/lic.diva-106227ISBN: 978-91-7519-351-9 (print)OAI: oai:DiVA.org:liu-106227DiVA: diva2:714719
Presentation
2014-06-02, Eken, Hus I, Campus Valla, Linköpings universitet, Linköping, 13:30 (Swedish)
Supervisors
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2014-04-29Bibliographically approved
List of papers
1. Cost-effectiveness of injury prevention - a systematic review of municipality based interventions.
Open this publication in new window or tab >>Cost-effectiveness of injury prevention - a systematic review of municipality based interventions.
2010 (English)In: Cost effectiveness and resource allocation : C/E, ISSN 1478-7547, Vol. 8, 17- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Injuries are a major cause of mortality and morbidity which together result in avoidable societal costs. Due to limited resources, injury prevention interventions need to demonstrate cost-effectiveness to justify their implementation. However, the existing knowledge in this area is limited. Consequently, a systematic review is needed to support decision-making and to assist in the targeting of future research. The aim of this review is to critically appraise the published economic evidence of injury prevention interventions at the municipal level. METHODS: A search strategy was developed to focus a literature search in PubMed, Embase, Cochrane and NHS EED. Studies were eligible for inclusion if they were economic evaluations of injury prevention interventions that could be implemented by municipalities; had a relevant comparison group; did not include any form of medication or drug use; and were assessed as having at least an acceptable quality from an economic point of view. Articles were screened in three steps. In the final step, studies were critically appraised using a check-list based on Drummond's check-list for assessing economic evaluations. RESULTS: Of 791 potential articles 20 were accepted for inclusion. Seven studies showed net savings; four showed a cost per health score gained; six showed both savings and a cost per health score gained but for different time horizons and populations; and three showed no effect. The interventions targeted a range of areas such as traffic safety, fire safety, hip fractures, and sport injuries. One studied a multi-targeted community-based program. Only six articles used effectiveness data generated within the study. CONCLUSIONS: The results indicate that there are injury prevention interventions that offer good use of societal resources. However, there is a lack of economic evidence surrounding injury prevention interventions. This lack of evidence needs to be met by further research about the economic aspects of injury prevention interventions to improve the information available for decision-making.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-61276 (URN)10.1186/1478-7547-8-17 (DOI)20831790 (PubMedID)
Available from: 2010-11-10 Created: 2010-11-10 Last updated: 2014-11-13Bibliographically approved
2. The societal costs of injuries: estimating the incidence and cost for different types of injuries in Sweden
Open this publication in new window or tab >>The societal costs of injuries: estimating the incidence and cost for different types of injuries in Sweden
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Knowledge about the costs for different types of injuries is crucial when estimating the benefits of a proposed injury prevention intervention. This study aims at estimating the societal costs for different injuries in Sweden.

Method: Medical costs for ICD-10 codes S00-S99, as well as the number of injured individuals for which the incidence was estimated, were collected from Östergötland County Council´s Cost Per Patient Database for the years 2009-2012. Productivity losses were estimated by using Swedish diagnosis-specific sick leave data from 2009 combined with labour costs. Total costs per injury were estimated for ten different injury groups relating to injured body part.

Results: The total average societal cost per injury for diagnoses S00-S99 was estimated at approximately € 2,726 for an estimated number of 708,105 injuries in Sweden 2009. Direct medical costs amount to approximately 43% of the total costs. There were however great differences between injuries: for instance, the lowest cost per injury was estimated at around € 892 and the highest at € 15,537 for the diagnostic groups Injuries to the ankle and foot, and Injuries to the neck, respectively. Great variation was also seen in the  share of medical costs: it varied between 10% and 84% between injury groups.

Conclusions: This study shows that the studied injuries are associated with considerable costs to society. There are also variations in costs between injuries and this information is valuable when estimating the benefits of interventions targeting different injuries. By combining cost and effectiveness data cost effectiveness can be estimated for different interventions. This is pivotal information when deciding which interventions to implement; that is, the ones that provide best value for money.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106225 (URN)
Available from: 2014-04-29 Created: 2014-04-29 Last updated: 2015-03-31Bibliographically approved

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