Understanding and Using Injury Cost Data in Your ......Incidence data are useful for assessing the...

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Understanding and Using Injury Cost Data in Your Prevention Efforts Rebecca Spicer, PhD MPH Dexter Taylor, PhD CSN Economics and Data Analysis Resource Center

Transcript of Understanding and Using Injury Cost Data in Your ......Incidence data are useful for assessing the...

Page 1: Understanding and Using Injury Cost Data in Your ......Incidence data are useful for assessing the magnitude of the problem Costs measure burden by accounting for multiple injury consequences

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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Rebecca Spicer, PhD, MPH Dexter Taylor, PhD

Presenters

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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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% 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

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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35

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

https://www.childrenssafetynetwork.org/publications/whatworks2014
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]

mailto:[email protected]
mailto:[email protected]
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