Robinson Luke Steven, Sarkies Mitchell, Brown Ted, O'Brien Lisa
Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia.
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
Injury. 2016 Dec;47(12):2614-2626. doi: 10.1016/j.injury.2016.09.041. Epub 2016 Oct 1.
Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity.
This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature.
A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries.
Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden.
手部和腕部受伤很常见，占所有急诊病例的20%。这些损伤的经济负担包括直接成本（产生的医疗费用）、间接成本（生产力损失的价值）和无形的成本，可能很高，且会随着损伤严重程度的增加而急剧上升。
本文系统回顾了关于急性手部和腕部损伤的疾病成本研究及卫生经济评估，特别关注直接、间接和无形的成本。旨在提供负担的经济成本估计，并讨论国际文献中使用的成本组成部分。
在多个数据库中检索了关于急性手部和腕部损伤的疾病成本研究及卫生经济评估。为每项纳入研究提取的数据包括：设计、人群、干预措施，以及直接、间接和无形的成本的估计和测量方法。使用历史汇率将报告的成本换算成美元，然后使用通货膨胀计算器将其调整为2015年的美元。结果：检索到764项研究，其中21项符合纳入标准。12项是疾病成本研究，7项是卫生经济评估。在所有研究中，用于得出直接、间接和无形的成本的方法显著不同。在疾病成本研究[64.5%（四分位间距50.75 - 88.25）]和卫生经济评估[68%（四分位间距49.25 - 73.5）]中，间接成本均占总成本的很大一部分。在疾病成本研究中，每种损伤类型每例的总成本中位数为6951美元（四分位间距3357美元 - 22274美元），在卫生经济评估中为8297美元（四分位间距3858美元 - 33939美元）。很少有研究报告与急性手部和腕部损伤相关的无形的成本数据。
多项研究试图使用不同的方法估计不同国家与急性手部和腕部损伤相关的直接、间接和无形的成本。不同急性手部和腕部损伤的经济成本估计因研究方法而异，然而，无论以何种标准衡量，这些损伤都应被视为对个人和社会的重大负担。采用标准化方法的进一步研究可以通过识别导致最大负担的主要疾病和暴露因素，为相关政策制定者提供关于如何最佳分配有限资源的指导。
