COVID-19 vaccination in Sindh Province, Pakistan: A modelling study of health impact and cost-effectiveness.

BACKGROUND: Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million). METHODS AND FINDINGS: We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question. CONCLUSIONS: COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.

The effects on mortality and the associated financial costs of wood heater pollution in a regional Australian city.

OBJECTIVES: To estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale. DESIGN: Health impact assessment (excess annual mortality and financial costs) based upon atmospheric PM2.5 measurements. SETTING: Armidale, a regional Australian city (population, 24 504) with high levels of air pollution in winter caused by domestic wood heaters, 1 May 2018 - 30 April 2019. MAIN OUTCOME MEASURES: Estimated population exposure to PM2.5 from wood heaters; estimated numbers of premature deaths and years of life lost. RESULTS: Fourteen premature deaths (95% CI, 12-17 deaths) per year, corresponding to 210 (95% CI, 172-249) years of life lost, are attributable to long term exposure to wood heater PM2.5 pollution in Armidale. The estimated financial cost is $32.8 million (95% CI, $27.0-38.5 million), or $10 930 (95% CI, $9004-12 822) per wood heater per year. CONCLUSIONS: The substantial mortality and financial cost attributable to wood heating in Armidale indicates that effective policies are needed to reduce wood heater pollution, including public education about the effects of wood smoke on health, subsidies that encourage residents to switch to less polluting home heating (perhaps as part of an economic recovery package), assistance for those affected by wood smoke from other people, and regulations that reduce wood heater use (eg, by not permitting new wood heaters and requiring existing units to be removed when houses are sold).

Quantifying health impacts and economic costs of PM2.5 exposure in Mexican cities of the National Urban System.

OBJECTIVES: To estimate avoidable mortality, potential years of life lost and economic costs associated with particulate matter PM2.5 exposure for 2 years (2013 and 2015) in Mexico using two scenarios of reduced concentrations (i.e., mean annual PM2.5 concentration < 12 µg/m3 and mean annual PM2.5 concentration < 10 µg/m3). METHODS: The health impact assessment method was followed. This method consists of: identification of health effects, selection of concentration-response functions, estimation of exposure, quantification of impacts quantification and economic assessment using the willingness to pay and human capital approaches. RESULTS: For 2013, we included data from 62 monitoring sites in ten cities, (113 municipalities) where 36,486,201 live. In 2015, we included 71 monitoring sites from fifteen cities (121 municipalities) and 40,479,629 inhabitants. It was observed that reduction in the annual PM2.5 average to 10 µg/would have prevented 14,666 deaths and 150,771 potential years of life lost in 2015, with estimated costs of 64,164 and 5434 million dollars, respectively. CONCLUSIONS: Reducing PM2.5 concentration in the Mexican cities studied would reduce mortality by all causes by 8.1%, representing important public health benefits.

Measurement and evaluation of quality of life and well-being in individuals having or having had fertility problems: a systematic review.

OBJECTIVES: The aims of this study were: (1) to identify which measurement instruments are used in practice to assess the quality of life or well-being of individuals with and without (sub)fertility; (2) to describe the design and outcomes of studies comparing quality of life or well-being of individuals with and without fertility problems; and (3) to determine which of the outcomes of the identified studies could be used in cost-utility studies. METHODS: A systematic literature review was performed of studies published before July 2018, using multiple databases. Included studies investigated (health-related) quality of life or well-being of individuals with fertility problems. The applied instruments were assessed, as were the outcomes and suitability for use in cost-utility studies. RESULTS: Twenty-six studies met the inclusion criteria. Twelve distinct instruments of measurement were applied: two generic quality-of-life instruments, five generic well-being instruments and five disease-specific instruments. Most studies found negative associations in one or more domains assessing fertility problems and quality of life or well-being. However, two studies found the opposite. None of the studies reported outcomes relevant for cost-utility studies. CONCLUSION: Quality of life and well-being related to having fertility problems are regularly studied. However, the reported information is not suitable for use in cost-utility studies. There is a clear need for studies investigating the impact of fertility problems on quality of life in a way that outcomes can be compared across studies and disease areas.

Prioritising action on occupational carcinogens in Europe: a socioeconomic and health impact assessment.

BACKGROUND: Work-related cancer is an important public health issue with a large financial impact on society. The key European legislative instrument is the Carcinogens and Mutagens Directive (2004/37/EC). In preparation for updating the Directive, the European Commission commissioned a study to provide a socioeconomic, health and environmental impact assessment. METHODS: The evaluation was undertaken for 25 preselected hazardous substances or mixtures. Estimates were made of the number of cases of cancer attributable to workplace exposure, both currently and in the future, with and without any regulatory interventions, and these data were used to estimate the financial health costs and benefits. RESULTS: It was estimated that if no action is taken there will be >700 000 attributable cancer deaths over the next 60 years for the substances assessed. However, there are only seven substances where the data suggest a clear benefit in terms of avoided cancer cases from introducing a binding limit at the levels considered. Overall, the costs of the proposed interventions were very high (up to [euro ]34 000 million) and the associated monetised health benefits were mostly less than the compliance costs. CONCLUSIONS: The strongest cases for the introduction of a limit value are for: respirable crystalline silica, hexavalent chromium, and hardwood dust.

Measuring research impact in Australia's medical research institutes: a scoping literature review of the objectives for and an assessment of the capabilities of research impact assessment frameworks.

BACKGROUND: Realising the economic potential of research institutions, including medical research institutes, represents a policy imperative for many Organisation for Economic Co-operation and Development nations. The assessment of research impact has consequently drawn increasing attention. Research impact assessment frameworks (RIAFs) provide a structure to assess research translation, but minimal research has examined whether alternative RIAFs realise the intended policy outcomes. This paper examines the objectives presented for RIAFs in light of economic imperatives to justify ongoing support for health and medical research investment, leverage productivity via commercialisation and outcome-efficiency gains in health systems, and ensure that translation and impact considerations are embedded into the research process. This paper sought to list the stated objectives for RIAFs, to identify existing frameworks and to evaluate whether the identified frameworks possessed the capabilities necessary to address the specified objectives. METHODS: A scoping review of the literature to identify objectives specified for RIAFs, inform upon descriptive criteria for each objective and identify existing RIAFs. Criteria were derived for each objective. The capability for the existing RIAFs to realise the alternative objectives was evaluated based upon these criteria. RESULTS: The collated objectives for RIAFs included accountability (top-down), transparency/accountability (bottom-up), advocacy, steering, value for money, management/learning and feedback/allocation, prospective orientation, and speed of translation. Of the 25 RIAFs identified, most satisfied objectives such as accountability and advocacy, which are largely sufficient for the first economic imperative to justify research investment. The frameworks primarily designed to optimise the speed of translation or enable the prospective orientation of research possessed qualities most likely to optimise the productive outcomes from research. However, the results show that few frameworks met the criteria for these objectives. CONCLUSION: It is imperative that the objective(s) for an assessment framework are explicit and that RIAFs are designed to realise these objectives. If the objectives include the capability to pro-actively drive productive research impacts, the potential for prospective orientation and a focus upon the speed of translation merits prioritisation. Frameworks designed to optimise research translation and impact, rather than simply assess impact, offer greater promise to contribute to the economic imperatives compelling their implementation.

The indirect costs of back problems (dorsopathies) in Australians aged 45 to 64 years from 2015 to 2030: results from a microsimulation model, Health&WealthMOD2030.

This study projected the indirect costs of back problems through lost productive life years (PLYs) from the individual's perspective (lost disposable income), the governmental perspective (reduced taxation revenue, greater welfare spending), and the societal perspective (lost gross domestic product, GDP) from 2015 to 2030, using Health&WealthMOD2030-Australia's first microsimulation model on the long-term impacts of ill-health. Quantile regression analysis was used to examine differences in median weekly income, welfare payments, and taxes of people unable to work due to back problems with working full-time without back problems as comparator. National costs and lost GDP resulting from missing workers due to back problems were also projected. We projected that 90,000 people have lost PLYs due to back problems in 2015, increasing to 104,600 in 2030 (16.2% increase). People with lost PLYs due to back problems are projected to receive AU$340.91 less in total income and AU$339.77 more in welfare payments per week than full-time workers without back problems in 2030 and pay no income tax on average. National costs consisted of a loss of AU$2931 million in annual income in 2015, increasing to AU$4660 million in 2030 (60% increase). For government, extra annual welfare payments are projected to increase from AU$1462 million in 2015 to AU$1709 million in 2030 (16.9% increase), and lost annual taxation revenue to increase from AU$671 million in 2015 to $961 million in 2030 (43.2% increase). We projected losses in GDP of AU$10,543 million in 2015, increasing to AU$14,522 million in 2030 due to back problems.

The assessment of health impacts and external costs of natural gas-fired power plant of Qom.

The external health damage costs of the combined cycle natural gas-fired power plant of Qom were investigated via the simplified impact pathway approach. Emitted particulate matter (PM10) and gaseous pollutants (NO x , CO, and SO2) from the power plant stack were measured The health effects and related costs were estimated by QUERI model from AirPacts according to the emissions, source and stack parameters, pollutant depletion velocities, exposure-response functions, local and regional population density, and detailed meteorological data. The results showed that the main health effect was assigned to the nitrate as restricted activity days (RAD) with 25,240 days/year. For all pollutants, the maximum health damage costs were related to the long-term mortality (49 %), restricted activity days (27 %), and chronic bronchitis (21 %). The annual health damage costs were approximately 4.76 million US$, with the cost being 0.096 US per kWh of generating electricity. Although the health damage costs of gas-fired power plant were lower than those of other heavy fuels, it seems essential to consider the health and environmental damages and focus on the emission control strategies, particularly in site selection for the new power plants and expanding the current ones.

Social inequality in morbidity, framed within the current economic crisis in Spain.

INTRODUCTION: Inspired by the 'Fundamental Cause Theory (FCT)' we explore social inequalities in preventable versus relatively less-preventable illnesses in Spain. The focus is on the education-health gradient, as education is one of the most important components of an individual's socioeconomic status (SES). Framed in the context of the recent economic crisis, we investigate the education gradient in depression, diabetes, and myocardial infarction (relatively highly preventable illnesses) and malignant tumors (less preventable), and whether this educational gradient varies across the regional-economic context and changes therein. METHODS: We use data from three waves of the Spanish National Health Survey (2003-2004, 2006-2007, and 2011-2012), and from the 2009-2010 wave of the European Health Survey in Spain, which results in a repeated cross-sectional design. Logistic multilevel regressions are performed with depression, diabetes, myocardial infarction, and malignant tumors as dependent variables. The multilevel design has three levels (the individual, period-regional, and regional level), which allows us to estimate both longitudinal and cross-sectional macro effects. The regional-economic context and changes therein are assessed using the real GDP growth rate and the low work intensity indicator. RESULTS: Education gradients in more-preventable illness are observed, while this is far less the case in our less-preventable disease group. Regional economic conditions seem to have a direct impact on depression among Spanish men (y-stand. OR = 1.04 [95 % CI: 1.01-1.07]). Diabetes is associated with cross-regional differences in low work intensity among men (y-stand. OR = 1.02 [95 % CI: 1.00-1.05]) and women (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]). Economic contraction increases the likelihood of having diabetes among men (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]), and smaller decreases in the real GDP growth rate are associated with lower likelihood of myocardial infarction among women (y-stand. OR = 0.83 [95 % CI: 0.69-1.00]). Finally, there are interesting associations between the macroeconomic changes across the crisis period and the likelihood of suffering from myocardial infarction among lower educated groups, and the likelihood of having depression and diabetes among less-educated women. CONCLUSION: Our findings partially support the predictions of the FCT for Spain. The crisis effects on health emerge especially in the case of our more-preventable illnesses and among lower educated groups. Health inequalities in Spain could increase rapidly in the coming years due to the differential effects of recession on socioeconomic groups.

The role of health impact assessment in advancing sustainable development in Latin America and the Caribbean.

The World Health Organization's (WHO's) Commission on Social Determinants of Health formally adopted Health Impact Assessment (HIA) more than a decade ago as a promising concept to address underlying health issues. Latin America and the Caribbean (LAC) remains one of the regions of the world with minimal application of HIA in public programs and policies. This special report documents the need for public mechanisms to incorporate HIA, the benefits from its application, and steps to promote its use. The authors discuss the role of HIA in the sustainable development of IAC to address social determinants of health.

The impact of Cochrane Reviews: a mixed-methods evaluation of outputs from Cochrane Review Groups supported by the National Institute for Health Research.

BACKGROUND: The last few decades have seen a growing emphasis on evidence-informed decision-making in health care. Systematic reviews, such as those produced by Cochrane, have been a key component of this movement. The National Institute for Health Research (NIHR) Systematic Review Programme currently supports 20 Cochrane Review Groups (CRGs) in the UK and it is important that this funding represents value for money. AIMS AND OBJECTIVES: The overall aim was to identify the impacts and likely impacts on health care, patient outcomes and value for money of Cochrane Reviews published by 20 NIHR-funded CRGs during the years 2007-11. DESIGN: We sent questionnaires to CRGs and review authors, undertook interviews with guideline developers (GDs) and used bibliometrics and documentary review to get an overview of CRG impact and to evaluate the impact of a sample of 60 Cochrane Reviews. The evaluation was guided by a framework with four categories (knowledge production, research targeting, informing policy development and impact on practice/services). RESULTS: A total of 3187 new and updated reviews were published on the Cochrane Database of Systematic Reviews between 2007 and 2011, 1502 (47%) of which were produced by the 20 CRGs funded by the NIHR. We found 40 examples where reviews appeared to have influenced primary research and reviews had contributed to the creation of new knowledge and stimulated debate. Twenty-seven of the 60 reviews had 100 or more citations in Google Scholar™ (Google, CA, USA). Overall, 483 systematic reviews had been cited in 247 sets of guidance. This included 62 sets of international guidance, 175 sets of national guidance (87 from the UK) and 10 examples of local guidance. Evidence from the interviews suggested that Cochrane Reviews often play an instrumental role in informing guidance, although reviews being a poor fit with guideline scope or methods, reviews being out of date and a lack of communication between CRGs and GDs were barriers to their use. Cochrane Reviews appeared to have led to a number of benefits to the health service including safer or more appropriate use of medication or other health technologies or the identification of new effective drugs or treatments. However, whether or not these changes were directly as a result of the Cochrane Review and not the result of subsequent clinical guidance was difficult to judge. Potential benefits of Cochrane Reviews included economic benefits through budget savings or the release of funds, improvements in clinical quality, the reduction in the use of unproven or unnecessary procedures and improvements in patient and carer experiences. CONCLUSIONS: This study identified a number of impacts and likely impacts of Cochrane Reviews. The clearest impacts of Cochrane Reviews are on research targeting and health-care policy, with less evidence of a direct impact on clinical practice and the organisation and delivery of NHS services. Although it is important for researchers to consider how they might increase the influence of their work, such impacts are difficult to measure. More work is required to develop suitable methods for defining and quantifying the impact of research. FUNDING: The NIHR Health Technology Assessment programme.

Global health impacts of policies: lessons from the UK.

BACKGROUND: The UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy "Health is Global". To facilitate this process, the Department of Health, in collaboration with the National Heart Forum, initiated a project to pilot the use of a global health impact assessment guidance framework and toolkit for policy-makers. This paper aims to stimulate debate about the desirability and feasibility of global health impact assessments by describing and drawing lessons from the first stage of the project. DISCUSSION: Despite the attraction of being able to assess and address potential global health impacts of policies, there is a dearth of existing information and experience. A literature review was followed by discussions with policy-makers and an online survey about potential barriers, preferred support mechanisms and potential policies on which to pilot the toolkit. Although policy-makers were willing to engage in hypothetical discussions about the methodology, difficulties in identifying potential pilots suggest a wider problem in encouraging take up without legislative imperatives. This is reinforced by the findings of the survey that barriers to uptake included lack of time, resources and expertise. We identified three lessons for future efforts to mainstream global health impact assessments: 1) Identify a lead government department and champion--to some extent, this role was fulfilled by the Department of Health, however, it lacked a high-level cross-government mechanism to support implementation. 2) Ensure adequate resources and consider embedding the goals and principles of global health impact assessments into existing processes to maximise those resources. 3) Develop an effective delivery mechanism involving both state actors, and non-state actors who can ensure a "voice" for constituencies who are affected by government policies and also provide the "demand" for the assessments. SUMMARY: This paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms.

Budget impact analysis of chronic kidney disease mass screening test in Japan.

BACKGROUND: Our recently published cost-effectiveness study on chronic kidney disease mass screening test in Japan evaluated the use of dipstick test, serum creatinine (Cr) assay or both in specific health checkup (SHC). Mandating the use of serum Cr assay additionally, or the continuation of current policy mandating dipstick test only was found cost-effective. This study aims to examine the affordability of previously suggested reforms. METHODS: Budget impact analysis was conducted assuming the economic model would be good for 15 years and applying a population projection. Costs expended by social insurers without discounting were counted as budgets. RESULTS: Annual budget impacts of mass screening compared with do-nothing scenario were calculated as ¥79-¥-1,067 million for dipstick test only, ¥2,505-¥9,235 million for serum Cr assay only and ¥2,517-¥9,251 million for the use of both during a 15-year period. Annual budget impacts associated with the reforms were calculated as ¥975-¥4,129 million for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥963-¥4,113 million for mandating serum Cr assay only and abandoning dipstick test. CONCLUSIONS: Estimated values associated with the reform from ¥963-¥4,129 million per year over 15 years are considerable amounts of money under limited resources. The most impressive finding of this study is the decreasing additional expenditures in dipstick test only scenario. This suggests that current policy which mandates dipstick test only would contain medical care expenditure.

The State of Alaska's early experience with institutionalization of health impact assessment.

BACKGROUND: Many nations routinely include health impact assessments (HIA) in public policy decisions. Institutionalization of HIA formally integrates health considerations into a governmental decision-making process. We describe an example of institutionalization in the United States through Alaska's early experience with institutionalization of HIA. LITERATURE REVIEW: HIA arose from a series of health conferences in the 1970s that affirmed the importance of "health for all." A number of key milestones eventually defined HIA as a unique field of impact assessment. There are several approaches to institutionalization, and one common approach in the United States is through the National Environmental Policy Act (NEPA). NEPA formed the basis for the earliest HIAs in Alaska. PROGRAM DESCRIPTION: Early HIAs in Alaska led to conferences, working groups, a state guidance document and the institutionalization of a HIA program within the Department of Health and Social Services in 2010. A medical epidemiologist staffs the program, which utilizes contractors to meet rising demand for HIA. The HIA program has sustainable funding from the state budget and from the state's natural resource permitting process. The HIA document is the main deliverable, but the program performs other tasks, including fieldwork and technical reviews. The HIA program works closely with a host of collaborative partners. CONCLUSION: Alaska's institutionalized HIA program benefits from sustainable funding that promotes continuous quality improvement and involves the program in the entire life cycle of a development project. The program structure adapts well to variations in workflow and supports a host of quality control activities. Currently, the program focuses on HIAs for natural resource development projects.

Cobenefits of replacing car trips with alternative transportation: a review of evidence and methodological issues.

It has been reported that motor vehicle emissions contribute nearly a quarter of world energy-related greenhouse gases and cause nonnegligible air pollution primarily in urban areas. Reducing car use and increasing ecofriendly alternative transport, such as public and active transport, are efficient approaches to mitigate harmful environmental impacts caused by a large amount of vehicle use. Besides the environmental benefits of promoting alternative transport, it can also induce other health and economic benefits. At present, a number of studies have been conducted to evaluate cobenefits from greenhouse gas mitigation policies. However, relatively few have focused specifically on the transport sector. A comprehensive understanding of the multiple benefits of alternative transport could assist with policy making in the areas of transport, health, and environment. However, there is no straightforward method which could estimate cobenefits effect at one time. In this paper, the links between vehicle emissions and air quality, as well as the health and economic benefits from alternative transport use, are considered, and methodological issues relating to the modelling of these cobenefits are discussed.

Economic impact of ambulatory care formulary restrictions at a large county health system.

PURPOSE: Study results documenting substantial cost savings achieved by an outpatient indigent-care pharmacy program through formulary modifications and optimized purchasing practices are presented. METHODS: Wholesale purchasing data were retrospectively evaluated to compare drug expenditures before and after a large Florida hospital's adoption of a tiered formulary system for three ambulatory care facilities serving mostly uninsured patients. The outcomes assessed included the average cost per prescription and total medication purchases before and after implementation of the tiered formulary, which was phased in over several months and accompanied by intensive educational programs targeting physicians and pharmacy staff. Other outcomes included cost avoidance resulting from an increased emphasis on patient assistance program (PAP) enrollment and the use of "bulk replacement" arrangements for prescription replenishment. RESULTS: During a designated nine-month postimplementation period, the average cost per prescription declined by 4.7% (from $19.86 to $18.92) relative to the baseline value. Six-month spending decreases of 36-58% from prior-year levels were achieved in 7 of the 10 most-purchased drug classes, with an overall 25% decline in medication purchases. Cost avoidance due to more aggressive use of PAPs and bulk replacement programs also yielded substantial program savings. CONCLUSION: Formulary streamlining and other cost-control initiatives at an outpatient pharmacy program were associated with a decrease in the average cost per prescription of $0.94 over a nine-month period. The primary endpoint showed a potential annualized savings of approximately $1 million.

The personal and national costs of CVD: impacts on income, taxes, government support payments and GDP due to lost labour force participation.

BACKGROUND: CVD has the ability to interrupt an individual's ability to participate in the labour force, and this can have considerable follow-up on impacts to both the individual and the state. This study aimed to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefit payments and lost GDP as a result of early retirement due to CVD in Australians aged 45-64 in 2009. METHODS: Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model. RESULTS: Individuals aged 45 to 64 years who have retired early due to CVD have a median value of total weekly income of only $268 whereas those who are employed full time are likely to have almost five times this. The national aggregate impact of CVD through the loss of labour force participation amongst 45 to 64 year olds, equated to around AU$1.1 billion in lost income, $AU225 million in lost income taxation revenue, AU$85 million in additional government benefit payments, and AU$748 million in lost GDP, in 2009 alone. CONCLUSIONS: The costs of CVD to both individuals and the state are considerable. Whilst individuals bear the economic costs of lost income in addition to the burden of the condition itself, the state impacts are loss of productivity from reduced workforce participation, lost income taxation revenue, and increasing government support payments - in addition to direct health care costs.

An assessment of China's PM10-related health economic losses in 2009.

Using GIS software and based on exposure-response functions, this paper estimated the health-related economic losses that China suffered in 2009 due to the presence of particulate matter (PM(10)). The results show that China suffered a health-related economic loss due to PM(10) of US$ 106.5 billion, or 2.1% of China's GDP, for the year 2009. Some urban areas, including Beijing, Tianjin, Shanghai, Guangzhou, Chongqing, and Changsha, reported large health-related economic losses due to PM(10), with a value of US$ 1.5 million per square kilometre or greater. Some parts of Beijing, Ji'nan, and Chongqing reported health-related economic losses due to PM(10) as being greater than 4% of the 2009 GDP.