understanding and using injury cost data in your ......incidence data are useful for assessing the...
TRANSCRIPT
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Understanding and Using Injury Cost Data in Your Prevention EffortsRebecca Spicer, PhD MPH
Dexter Taylor, PhD
CSN Economics and Data Analysis Resource Center
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www.ChildrensSafetyNetwork.org 2
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www.ChildrensSafetyNetwork.org 3
Rebecca Spicer, PhD, MPH Dexter Taylor, PhD
Presenters
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www.ChildrensSafetyNetwork.org 4
Why Use Cost Data?
Incidence data are useful for assessing the magnitude of the problem
Costs measure burden by accounting for multiple injury consequences – death, severity, disability, body
region, nature of injury – in a single unit of measurement.
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Fatal and Severe Injury, Ages 0-19, U.S., 2012
Data Sources: Deaths - NCHS Vital Statistics System, 2012, CDC WISQARS, Fatal Injury Data query
Hospitalizations - Healthcare Utilization Project, Nationwide Inpatient Sample, 2012
ED Visits – Healthcare Utilization Project, Nationwide Emergency Department Sample, 2012
Fatal
13,076
<1%
Hospitalized
294,000
3%
ED, Treated
and released
8,898,000
96%
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Fatal and Severe Injury, Ages 0-19, US, 2012:
$594.4 Billion
Data Sources: Deaths - NCHS Vital Statistics System, 2012, CDC WISQARS, Fatal Injury Data query
Hospitalizations - Healthcare Utilization Project, Nationwide Inpatient Sample, 2012
ED Visits – Healthcare Utilization Project, Nationwide Emergency Department Sample, 2012
Fatal
$101.7 B
17%
Hospitalized
$129.4 B
22%
ED, Treated
and released
$362.2 B
60%
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www.ChildrensSafetyNetwork.org 7
% of Medical Spending by Condition, Ages 0-19, United States, 2008
Injury,
15.7%
Ear, Nose,
Throat,
7.5%
Asthma,
18.2%
Mental
Disorder,
24.5%
Other
Infectious,
12.6%
Other,
21.5%
Source: National Medical Expenditure Panel Survey, 2008
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Cost Categories (2012 US$)
Work Loss (productivity) includes wages, fringe benefits and household
work for adults. It includes short-term work loss and the present value of a
lifetime's worth of wage and household work that a child will be unable to
do if he or she is killed or permanently disabled.
Medical costs include emergency medical care, acute care (in hospital,
clinic, and office settings), rehabilitation, follow-up care (including
physician, allied health, and mental health care), long-term medical and
institutional care, prescriptions, ancillary expenses, coroner services, and
the costs of health insurance claims processing.
Quality of life costs place a dollar value on the pain, suffering, and lost
quality of life that children and their families experience due to death and
injury.
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Fatal and Severe Injury, Ages 0-19, US, 2012:
$594.4 Billion
5%11%
84%
Medical: $29.0B
Work Loss: $63.2 B
Quality of Life: $502.2B
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$29.0 Billion$63.2 Billion
$502.2 Billion
Medical Work Loss Quality of Life
ED Visit Hospitalized Fatal
Cost of Severe and Fatal Injury, Ages 0-19, US, 2012: $594.4 Billion
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Average Cost per Hospitalized Injury, for Selected Causes, Ages 0-19
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
$180,000
$200,000
Medical Cost
Work Loss
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Using the CDC WISQARS Cost Module
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• https://www.cdc.gov/injury/wisqars
Cost of Injury Reports
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Cost of Injury Reports
Reports show estimated injury costs associated with
three levels of treatment:
• Death,
• Hospitalization, or
• ED treated and released.
These injuries can be classified by
• Intent, Mechanism, and Intent x Mechanism, or by
• Body Region, Nature of Injury, and Body Region x Nature of
Injury
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Cost of Injury Reports
In addition, the following characteristics can be selected for
cost estimates:
• sex
• age or age group
• medical costs, work loss costs, or both
• national-, regional-, or state-level prices
• indexing prices for specific calendar years
Cost of Injury Reports Help Menu:
• http://www.cdc.gov/injury/wisqars/cost_help/index.html
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Example: Unintentional MVT Deaths
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Example: Unintentional MVT Deaths
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Example: Unintentional MVT Deaths
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Example: Unintentional MVT Deaths
Pop-Up Blocked
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Example: Unintentional MVT Deaths
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Example: Unintentional MVT Deaths
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Example: Unintentional MVT Deaths, MD
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Example: Unintentional MVT Deaths, MD
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Example: Unintentional MVT Deaths, MD
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Example: Unintentional MVT Deaths, MD
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Example: Unintentional MVT Deaths, MD
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Example: Unintentional MVT Hospitalizations, MD
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Example: Unintentional MVT Hospitalizations, MD
https://www.childrenssafetynetwork.org/sites/childrenssafetynetwork.org/files/Maryland2016.pdf
https://www.childrenssafetynetwork.org/states
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Example: Unintentional MVT Hospitalizations, MD
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Example: Unintentional MVT Hospitalizations, MD
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Example: Unintentional MVT Hospitalizations, MD
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Example: Unintentional MVT Hospitalizations, MD
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• Priority Setting
• Education
• Selection of Interventions
Usefulness of Cost Analyses
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• Can compare different problems using one common unit ($)
• Informs resource allocation
• Using cost of injury places a greater weight on severe nonfatal injuries
Priority-Setting
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Leading Causes of Hospitalized Injury Costs, United States, 2013
Rank Age 0-4 Age 5-9 Age 10-14 Age 15-19
Fall Fall Fall MVT Occupant
Assault MVT Pedestrian Struck by/Against Fall
Unspecified Struck by/against MVT Pedestrian Assault
2,720
Struck by/against Pedalcyclist, Transport, other Struck by/against
non-MVT
MVT Occupant Transport, other Pedalcyclist Transport, other
non-MVT
Hot obj/subst MVT Occupant MVT Occupant Self-Inflicted
Submersion Other Spec Self-Inflicted MVT Pedestrian
Other Spec Submersion Assault MVT Motorcyclist
Bites/stings Bites/stings MVT Pedalcyclist Pedalcyclist
non-MVT
MVT Assault Unspecified Unspecified
1
2
3
4
7
8
9
10
5
6
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Research Priorities
Source: Miller, Romano, and
Spicer (2000). The cost of
childhood unintentional
Injuries and the value of
prevention. The Future of
Children, 10(1):137-163.
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• Convey injury prevention in a way that captures the attention of policy-makers, the media, and the public
Education
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Selected Cost-Benefit Analyses
Every Dollar Spent OnSaves Society
(in 2013 dollars)
Childproof Cigarette Lighter $77
Booster Seat $71
Bicycle Helmet $48
Child Safety Seat $42
Zero Alcohol Tolerance, Driver Under 21 $25
Smoke Alarm $17
Pediatrician Counseling $9
Poison Control Center $8
Children’s Safety Network, Injury Prevention: What Works? A summary of cost outcome analysis for injury prevention
programs (2013 update).
Source: Children’s Safety Network,
Injury Prevention: What Works?
A summary of cost outcome analysis for injury prevention programs (2014 update).
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Resource
https://www.childrenssafetynetwork.org/publications/whatworks2014
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• Who benefits from injury prevention?
Who Pays?
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Every Bicycle Helmet Saves Insurers $41
$12
$29
Auto Health
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The Government Pays, Select Causes
2/8/2013
62% 60% 56% 55% 51%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Unint/Firearm Assault Unint/Bite,Sting Unint/Hot
Substance
Unint/Poisoning
Private/Other Medicaid
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Example: Cost of Child and Adolescent Injuries in Central Harlem versus Washington Heights
Washington Heights
Central Harlem
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The Data
Body Part Nature of Injury
Central
Harlem
Washington
HeightsHead and Neck Fracture *** ***
Head and Neck Dislocation *** ***
Head and Neck Sprain/Strain *** ***
Head and Neck Internal *** ***
Head and Neck Open wound *** ***
Head and Neck Amputation *** ***
Head and Neck Blood Vessel *** ***
Head and Neck Superficial/Contusion *** ***
Head and Neck Crushing *** ***
Head and Neck Burn *** ***
Head and Neck Nerve Damage *** ***
Head and Neck Other *** ***
Torso Fracture *** ***
Torso Dislocation *** ***
Torso Sprain/Strain *** ***
Torso Internal *** ***
Torso Open wound *** ***
Torso Amputation *** ***
Torso Blood Vessel *** ***
Torso Superficial/Contusion *** ***
Torso Crushing *** ***
Torso Burn *** ***
Torso Nerve Damage *** ***
Torso Other *** ***
Extremities Fracture *** ***
Extremities Dislocation *** ***
Extremities Sprain/Strain *** ***
Extremities Internal *** ***
Extremities Open wound *** ***
Extremities Amputation *** ***
Extremities Blood Vessel *** ***
Extremities Superficial/Contusion *** ***
Extremities Crushing *** ***
Extremities Burn *** ***
Extremities Nerve Damage *** ***
Extremities Other *** ***
Unclassified Fracture *** ***
Unclassified Dislocation *** ***
Unclassified Sprain/Strain *** ***
Unclassified Internal *** ***
Unclassified Open wound *** ***
Unclassified Amputation *** ***
Unclassified Blood Vessel *** ***
Unclassified Superficial/Contusion *** ***
Unclassified Crushing *** ***
Unclassified Burn *** ***
Unclassified Nerve Damage *** ***
Unclassified Other *** ***
System-Wide System-Wide *** ***
Obtained from the Northern Manhattan
Injury Surveillance System (NMISS)
Case Definition:
• Hospitalization for assault,
gunshot, outdoor fall and traffic
injury
• Age 5-16
• Years 1985-1988
Central Harlem Washington Hts
Population 19,000 43,000
Hospitalizations,
1985-1988568 818
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Using
WISQARS,
compute the
medical
spending on
these Injuries.
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• The cost per 1000 children in Harlem was 1.37 times that of Washington Heights
• Implemented late 1988: Harlem Hospital Injury Prevention Program (HHIPP)
Findings
Central Harlem Washington Hts
Injuries*, 1985-1988 568 818
Population 19,000 43,000
Total Medical
Spending$13,590,514 $21,550,401
Medical spending
per 1000 children$698,000 $508,000
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Example: Benefit Cost Anaylsis of the Harlem Hospital Injury Prevention Program
Source: Spicer, Miller, Durkin, Barlow (2004). A benefit-cost analysis of the Harlem hospital injury prevention program. Injury
Control and Safety Promotion, 11(1):55-57.
The HHIPP: Hospital-based program targeting assault, gunshot, outdoor fall
and traffic injuries among kids ages 5-16 years. Implemented late 1988
Data: Obtained from the Northern Manhattan Injury Surveillance System
Design: Case (Central Harlem) versus Control (Washington Heights),
Pre- versus Post-Intervention Design
Central Harlem Washington Hts
Pre-Intervention
(1985-88)$508,000/1000 $598,000/1000
Post-Intervention
(1989-1992)$420,000/1000 $425,000/1000
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The Data
Body Part Nature of Injury
Central
Harlem
Washington
Heights
Central
Harlem
Washington
HeightsHead and Neck Fracture *** *** *** ***
Head and Neck Dislocation *** *** *** ***
Head and Neck Sprain/Strain *** *** *** ***
Head and Neck Internal *** *** *** ***
Head and Neck Open wound *** *** *** ***
Head and Neck Amputation *** *** *** ***
Head and Neck Blood Vessel *** *** *** ***
Head and Neck Superficial/Contusion *** *** *** ***
Head and Neck Crushing *** *** *** ***
Head and Neck Burn *** *** *** ***
Head and Neck Nerve Damage *** *** *** ***
Head and Neck Other *** *** *** ***
Torso Fracture *** *** *** ***
Torso Dislocation *** *** *** ***
Torso Sprain/Strain *** *** *** ***
Torso Internal *** *** *** ***
Torso Open wound *** *** *** ***
Torso Amputation *** *** *** ***
Torso Blood Vessel *** *** *** ***
Torso Superficial/Contusion *** *** *** ***
Torso Crushing *** *** *** ***
Torso Burn *** *** *** ***
Torso Nerve Damage *** *** *** ***
Torso Other *** *** *** ***
Extremities Fracture *** *** *** ***
Extremities Dislocation *** *** *** ***
Extremities Sprain/Strain *** *** *** ***
Extremities Internal *** *** *** ***
Extremities Open wound *** *** *** ***
Extremities Amputation *** *** *** ***
Extremities Blood Vessel *** *** *** ***
Extremities Superficial/Contusion *** *** *** ***
Extremities Crushing *** *** *** ***
Extremities Burn *** *** *** ***
Extremities Nerve Damage *** *** *** ***
Extremities Other *** *** *** ***
Unclassified Fracture *** *** *** ***
Unclassified Dislocation *** *** *** ***
Unclassified Sprain/Strain *** *** *** ***
Unclassified Internal *** *** *** ***
Unclassified Open wound *** *** *** ***
Unclassified Amputation *** *** *** ***
Unclassified Blood Vessel *** *** *** ***
Unclassified Superficial/Contusion *** *** *** ***
Unclassified Crushing *** *** *** ***
Unclassified Burn *** *** *** ***
Unclassified Nerve Damage *** *** *** ***
Unclassified Other *** *** *** ***
System-Wide System-Wide *** *** *** ***
Pre-Intervention Post-Intervention
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Results
Central Harlem Washington Heights
Medical spending per 1000 children 5-16 years
Pre-intervention
1985 $140,000 $91,000
1986 $108,000 $83,000
1987 $343,000 $149,000
1988 $107,000 $185,000
Total Pre-Intervention $698,000 $508,000
Post-intervention
1989 $99,000 $174,000
1990 $138,000 $91,000
1991 $107,000 $100,000
1992 $81,000 $55,000
Total Post-Intervention $425,000 $420,000
Savings from injuries prevented
Step 1: % Change pre- versus post-intervention 39.1% 17.3%
Step 2: % Change attributed to HHIPPb
21.8%
Step 3: Savings/1000 children attributed to HHIPPc
$152,000
Step 4: Total savingsd
$2,922,000
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Four years of the HHIPP cost $1.2 million
Cost of Program
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$2.922 million in medical spending averted
$1.2 million spent on the program
BCR = 2.44
Benefit-Cost Ratio
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Contact Information
Rebecca Spicer, PhD, MPH [email protected]
Dexter Taylor, PhD [email protected]
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