Economic Cost of U.S. Suicide and Nonfatal Self-harm.

INTRODUCTION: The U.S. age-adjusted suicide rate is 35% higher than two decades ago and the COVID-19 pandemic era highlighted the urgent need to address nonfatal self-harm, particularly among youth. This study aimed to report the estimated annual economic cost of U.S. suicide and nonfatal self-harm. METHODS: In 2023 CDC's WISQARS Cost of Injury provided the retrospective number of suicides and nonfatal self-harm injury emergency department (ED) visits from national surveillance sources by sex and age group, as well as the estimated annual economic cost of associated medical spending, lost work productivity, reduced quality of life from injury morbidity, and avoidable mortality based on the value of statistical life during 2015-2020. RESULTS: The economic cost of suicide and nonfatal self-harm averaged $510 billion (2020 USD) annually, the majority from life years lost to suicide. Working-aged adults (aged 25-64 years) comprised nearly 75% of the average annual economic cost of suicide ($356B of $484B) and children and younger adults (aged 10-44 years) comprised nearly 75% of the average annual economic cost of nonfatal self-harm injuries ($19B of $26B). CONCLUSIONS: Suicide and self-harm have substantial societal costs. Measuring the consequences in terms of comprehensive economic cost can inform investments in suicide prevention strategies.

Adverse Childhood Experiences Among U.S. Adults: National and State Estimates by Adversity Type, 2019-2020.

INTRODUCTION: Although adverse childhood experiences (ACEs) are associated with lifelong health harms, current surveillance data on exposures to childhood adversity among adults are either unavailable or incomplete for many states. In this study, recent data from a nationally representative survey were used to obtain the current and complete estimates of ACEs at the national and state levels. METHODS: Current, complete, by-state estimates of adverse childhood experiences were obtained by applying small area estimation technique to individual-level data on adults aged ≥18 years from 2019-2020 Behavioral Risk Factor Surveillance System survey. The standardized questions about childhood adversity included in the 2019-2020 survey allowed for obtaining estimates of ACE consistent across states. All missing responses to childhood adversity questions (states did not offer such questions or offered them to only some respondents; respondents skipped questions) were predicted through multilevel mixed-effects logistic small area estimation regressions. The analyses were conducted between October 2022 and May 2023. RESULTS: An estimated 62.8% of U.S. adults had past exposure to ACEs (range: 54.9% in Connecticut; 72.5% in Maine). Emotional abuse (34.5%) was the most common; household member incarceration (10.6%) was the least common. Sexual abuse varied markedly between females (22.2%) and males (5.4%). Exposure to most types of adverse childhood experiences was lowest for adults who were non-Hispanic White, had the highest level of education (college degree) or income (annual income ≥$50,000), or had access to a personal healthcare provider. CONCLUSIONS: Current complete estimates of ACEs demonstrate high countrywide exposures and stark sociodemographic inequalities in the burden, highlighting opportunities to prevent adverse childhood experiences by focusing social, educational, medical, and public health interventions on populations disproportionately impacted.

Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial.

BACKGROUND: The Center for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial. OBJECTIVE: This study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting. METHODS: STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)-led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment. RESULTS: The study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025. CONCLUSIONS: The STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention's effectiveness and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/54395.

Adults' exposure to adverse childhood experiences in the United States nationwide and in each state: modeled estimates from 2019-2020.

BACKGROUND: Although preventable, adverse childhood experiences (ACEs) can result in lifelong health harms. Current surveillance data on adults' exposure to ACEs are either unavailable or incomplete for many U.S. states. METHODS: Current estimates of the proportion of U.S. adults with past ACEs exposures were obtained by analysing individual-level data from 2019 to 2020 Behavioural Risk Factor Surveillance System-annual nationally representative survey of noninstitutionalized adults aged 18+years. Standardised questions measuring ACEs exposures (presence of household member with mental illness, substance abuse, or incarceration; parental separation; witnessing intimate partner violence; experiencing physical, emotional, or sexual abuse during childhood) were categorised into 0, 1, 2-3, or 4+ACEs and reported by sociodemographic group in each state. Missing ACEs responses (state did not offer ACEs questions or offered to only some respondents; respondent skipped questions) were modelled through multilevel mixed-effects logistic (MMEL) and jackknifed MMEL regressions. RESULTS: In 2019-2020, an estimated 62.8% of U.S. adults had past exposure to 1+ACEs (range: 54.9% in Connecticut; 72.5% in Maine), including 22.4% of adults who were exposed to 4+ACEs (range: 11.9% in Connecticut; 32.8% in Nevada). At the national and state levels, exposure to 4+ACEs was highest among adults aged 18-34 years, those who did not graduate from high school, or adults who did not have a healthcare provider. Racial/ethnic distribution of adults exposed to 4+ACEs varied by age and state. CONCLUSIONS: ACEs are common but not equally distributed. ACEs exposures estimated by state and sociodemographic group can help decisionmakers focus public health interventions on populations disproportionately impacted in their area.

Systematic Review of Per Person Violence Costs.

INTRODUCTION: Data on the long-term and comprehensive cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. This review aimed to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health economic research and decision making. METHODS: In 2023, English-language peer-reviewed journal articles published in 2000-2022 with a focus on high-income countries reporting original per-person average cost of violence estimates were identified using index terms in multiple databases. Study contents, including violence type (e.g., adverse childhood experiences), timeline and payer cost perspective (e.g., hospitalization event-only healthcare payer cost), and associated per-person cost estimates, were summarized. Costs were in 2022 U.S. dollars. RESULTS: Per-person cost estimates related to adverse childhood experiences, community violence, sexual violence, intimate partner violence, homicide, firearm violence, youth violence, workplace violence, and bullying from 73 studies (majority focusing on the U.S.) were summarized. For example, among 23 studies with a focus on adverse childhood experiences, monetary estimates ranged from $390 for adverse childhood experience-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 adverse childhood experiences to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality. CONCLUSIONS: This review provides a descriptive summary of available per-person cost of violence estimates. Results can help public health professionals to describe the economic burden of violence, identify the best available estimate for a particular public health question, and address data gaps. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to anticipate the economic benefits of prevention.

The Health and Economic Impact of Youth Violence by Injury Mechanism.

INTRODUCTION: Violence is a leading cause of morbidity and mortality among U.S. youth. More information on the health and economic burden of the most frequent assault mechanisms-or, causes (e.g., firearms, cut/pierce)-can support the development and implementation of effective public health strategies. Using nationally representative data sources, this study estimated the annual health and economic burden of U.S. youth violence by injury mechanism. METHODS: In 2023, CDC's WISQARS provided the number of homicides and nonfatal assault ED visits by injury mechanism among U.S. youth aged 10-24 years in 2020, as well as the associated average economic costs of medical care, lost work, morbidity-related reduced quality of life, and value of statistical life. The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample provided supplemental nonfatal assault incidence data for comprehensive reporting by injury mechanism. RESULTS: Of the $86B estimated annual economic burden of youth homicide, $78B was caused by firearms, $4B by cut/pierce injuries, and $1B by unspecified causes. Of the $36B billion estimated economic burden of nonfatal youth violence injuries, $19B was caused by struck by/against injuries, $3B by firearm injuries, and $365M by cut/pierce injuries. CONCLUSIONS: The lethality of assault injuries affecting youth when a weapon is explicitly or likely involved is high-firearms and cut/pierce injuries combined account for nearly all youth homicides compared to one-tenth of nonfatal assault injury ED visits. There are numerous evidence-based policies, programs, and practices to reduce the number of lives lost or negatively impacted by youth violence.

Suicide Rates by Industry and Occupation - National Vital Statistics System, United States, 2021.

The suicide rate among the U.S. working-age population has increased approximately 33% during the last 2 decades. To guide suicide prevention strategies, CDC analyzed suicide deaths by industry and occupation in 49 states, using data from the 2021 National Vital Statistics System. Industry (the business activity of a person's employer or, if self-employed, their own business) and occupation (a person's job or the type of work they do) are distinct ways to categorize employment. The overall suicide rates by sex in the civilian noninstitutionalized working population were 32.0 per 100,000 among males and 8.0 per 100,000 among females. Major industry groups with the highest suicide rates included Mining (males = 72.0); Construction (males = 56.0; females = 10.4); Other Services (e.g., automotive repair; males = 50.6; females = 10.4); Arts, Entertainment, and Recreation (males = 47.9; females = 15.0); and Agriculture, Forestry, Fishing, and Hunting (males = 47.9). Major occupation groups with the highest suicide rates included Construction and Extraction (males = 65.6; females = 25.3); Farming, Fishing, and Forestry (e.g., agricultural workers; males = 49.9); Personal Care and Service (males = 47.1; females = 15.9); Installation, Maintenance, and Repair (males = 46.0; females = 26.6); and Arts, Design, Entertainment, Sports, and Media (males = 44.5; females = 14.1). By integrating recommended programs, practices, and training into existing policies, workplaces can be important settings for suicide prevention. CDC provides evidence-based suicide prevention strategies in its Suicide Prevention Resource for Action and Critical Steps Your Workplace Can Take Today to Prevent Suicide, NIOSH Science Blog.

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults.

Importance: Adverse childhood experiences (ACEs) are preventable, potentially traumatic events in childhood, such as experiencing abuse or neglect, witnessing violence, or living in a household with substance use disorder, mental health problems, or instability from parental separation or incarceration. Adults who had ACEs have more harmful risk behaviors and worse health outcomes; the economic burden associated with these issues is uncertain. Objective: To estimate the economic burden of ACE-associated health conditions among US adults. Design, Setting, and Participants: In this economic evaluation, regression models of cross-sectional survey data from the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and previous studies were used to estimate ACE population-attributable fractions (PAFs) (ie, the fraction of total cases associated with a specific exposure) for selected health outcomes (anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, and violence) and risk factors (heavy drinking, illicit drug use, overweight and obesity, and smoking) among the 2019 US adult population. Adverse childhood experience PAFs were used to calculate the proportion of total condition-specific medical spending and lost healthy life-years related to ACEs using Global Burden of Disease Study data. Data analysis was performed from September 10, 2021, to November 29, 2022. Exposure: Adverse childhood experiences (age <18 years). Main Outcomes and Measures: Monetary valuation of ACE-associated morbidity and mortality using standard US value of statistical life methods and presented in terms of annual and lifetime per affected person and total population estimates at the national and state levels. Results: A total of 820 673 adults, representing 255 million individuals, participated in the BRFSS in 2019 and 2020. An estimated 160 million of the total 255 million US adult population (63%) had 1 or more ACE, associated with an annual economic burden of $14.1 trillion ($183 billion in direct medical spending and $13.9 trillion in lost healthy life-years). This was $88 000 per affected adult annually and $2.4 million over their lifetimes. The lifetime economic burden per affected adult was lowest in North Dakota ($1.3 million) and highest in Arkansas ($4.3 million). Twenty-two percent of adults had 4 or more ACEs and comprised 58% of the total economic burden-the estimated per person lifetime economic burden for those adults was $4.0 million. Conclusions and Relevance: In this cross-sectional analysis of the US adult population, the economic burden of ACE-related health conditions was substantial. The findings suggest that measuring the economic burden of ACEs can support decision-making about investing in strategies to improve population health.

Professional Fees for U.S. Hospital Care, 2016-2020.

BACKGROUND: The latest comprehensive diagnosis-specific estimates of hospital professional fees relative to facility fees are from 2004 to 2012. OBJECTIVE: Update professional fee ratio (PFR) estimates to improve cost analysis opportunities with hospital discharge data sources and compare them with previous PFR estimates. SUBJECTS: 2016-2020 MarketScan inpatient admissions and emergency department (ED) treat and release claims. MEASURES: PFR was calculated as total admission or ED visit payment divided by facility-only payment. This measure can be multiplied by hospital facility costs to yield a total cost estimate. RESEARCH DESIGN: Generalized linear regression models controlling for selected patient and service characteristics were used to calculate adjusted mean PFR per admission or ED visit by health payer type (commercial or Medicaid) and by selected diagnostic categories representing all clinical diagnoses (Major Diagnostic Category, Diagnostic Related Group, and Clinical Classification Software Revised). RESULTS: Mean 2016-2020 PFR was 1.224 for admissions with commercial payers (n = 6.7 million admissions) and 1.178 for Medicaid (n = 4.2 million), indicating professional payments on average increased total payments by 22.4% and 17.8%, respectively, above facility-only payments. This is a 9% and 3% decline in PFR, respectively, compared with 2004 estimates. PFR for ED visits during 2016-2020 was 1.283 for commercial payers (n = 22.2 million visits) and 1.415 for Medicaid (n = 17.7 million). This is a 12% and 5% decline in PFR, respectively, compared with 2004 estimates. CONCLUSIONS: Professional fees comprise a declining proportion of hospital-based care costs. Adjustments for professional fees are recommended when hospital facility-only financial data are used to estimate hospital care costs.

Economic Burden of US Youth Violence Injuries.

This economic evaluation study reports the annual economic burden of youth violence injuries using the most recent national data.

Inventory of U.S. Public Data Sources to Measure the Socioeconomic Impact of Experiencing Interpersonal Violence.

Introduction: There is limited recent information regarding the impact of interpersonal violence on an individual's non-health-related experiences and attainment, including criminal activity, education, employment, family status, housing, income, quality of life, or wealth. This study aimed to identify publicly available representative data sources to measure the socioeconomic impact of experiencing interpersonal violence in the U.S. Methods: In 2022, the authors reviewed data sources indexed in Data.gov, the Inter-university Consortium for Political and Social Research data archive, and the U.S. Census Bureau's Federal Statistical Research Data Center network to identify sources that reported both nonfatal violence exposure and socioeconomic status-or data sources linking opportunities to achieve both measures-over time (i.e., longitudinal/repeated cross-sections) at the individual level. Relevant data sources were characterized in terms of data type (e.g., survey), violence measure type (e.g., intimate partner violence), socioeconomic measure type (e.g., income), data years, and geographic coverage. Results: Sixteen data sources were identified. Adverse childhood experiences, intimate partner violence, and sexual violence were the most common types of violence faced. Income, education, and family status were the most common socioeconomic measures. Linked administrative data offered the broadest and the most in-depth analytical opportunities. Conclusions: Currently, linked administrative data appears to offer the most comprehensive opportunities to examine the long-term impact of violence on individuals' livelihoods. This type of data infrastructure may provide cost-effective research opportunities to better understand the elements of the economic burden of violence and improve targeting of prevention strategies.

Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population.

Importance: Direct costs of substance use disorders (SUDs) in the United States are incurred primarily among the working-age population. Quantifying the medical cost of SUDs in the employer-sponsored insurance (ESI) population can improve understanding of how SUDs are affecting workplaces and inform decision-making on the value of prevention strategies. Objective: To estimate the annual attributable medical cost of SUDs in the ESI population from the health care payer perspective. Design, Setting, and Participants: In this economic evaluation, Merative MarketScan 2018 databases were weighted to represent the non-Medicare eligible ESI population. Regression and mathematical modeling of medical expenditures controlled for insurance enrollee demographic, clinical, and insurance factors to compare enrollees with and without an SUD diagnosis to identify the annual attributable medical cost of SUDs. Data analysis was conducted from January to March 2022. Exposures: International Statistical Classification of Diseases, Tenth Revision, Clinical Modification SUD diagnoses on inpatient or outpatient medical records according to Clinical Classifications Software categories (alcohol-, cannabis-, hallucinogen-, inhalant-, opioid-, sedative-, stimulant-, and other substance-related disorders). Main Outcomes and Measures: Annual SUD medical cost in the ESI population overall and by substance type (eg, alcohol). Number of enrollees with an SUD diagnosis and the annual mean cost per affected enrollee of SUD diagnosis (any and by substance type) are also reported. Results: Among 162 million ESI enrollees, 2.3 million (1.4%) had an SUD diagnosis in 2018. The regression analysis sample included 210 225 individuals with an SUD diagnosis (121 357 [57.7%] male individuals; 68 325 [32.5%] aged 25-44 years) and 1 049 539 individuals with no SUD diagnosis. The mean annual medical cost attributable to SUD diagnosis per affected enrollee was $15 640 (95% CI, $15 340-$15 940), and the total annual medical cost in the ESI population was $35.3 billion (2018 USD). Alcohol use disorder ($10.2 billion) and opioid use disorder ($7.3 billion) were the most costly. Conclusions and Relevance: In this economic evaluation of medical expenditures in the ESI population, the per-person and total medical costs of SUDs were substantial. Strategies to support employees and their health insurance dependents to prevent and treat SUDs can be considered in terms of potentially offsetting the existing high medical cost of SUDs. Medical expenditures for SUDs represent the minimum direct cost that employers and health insurers face because not all people with SUDs have a diagnosis, and costs related to absenteeism, presenteeism, job retention, and mortality are not addressed.

WISQARS Cost of Injury for public health research and practice.

AIM: Since 2011 the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS) has demonstrated per-injury average and population total medical and non-medical costs of injuries by type (such as unintentional cut/pierce) in the USA. This article describes the impact of data and methods changes in the newest version of WISQARS Cost of Injury. METHODS: Data sources and methods were compared for the legacy version of the WISQARS Cost of Injury website (available 2011-2021; most recent prior update was published in 2014 with 2010 injury incidence and costs) and the new version (published 2021; 2015-present injury incidence and costs). Cost data sources were updated for the new website and the basis for medical costs and non-fatal injury work loss costs changed from mathematical modelling (combined estimates from multiple data sources) in the legacy website to statistical modelling of actual injury-related medical and work loss financial transactions in the new website. Monetary valuation of non-medical costs for injury deaths changed from lost employment income and household work in the legacy website to value of statistical life. Quality of life loss costs were added for non-fatal injuries. Per-injury average medical and non-medical costs by injury type (mechanism and intent) and total population injury costs were compared for years 2010 (legacy website data) and 2020 (new website data) to illustrate the impact of data and methods changes on reported costs in the context of changed annual injury incidence. RESULTS: Owing to more comprehensive cost capture yielding higher per-injury average costs for most injury types-including those with high incidence in 2020 such as unintentional poisoning and unintentional falls-reported total US medical and non-medical injury costs were substantially higher in 2020 (US$4.6 trillion) compared with 2010 (US$693 billion) (both 2020 USD). CONCLUSIONS AND RELEVANCE: New data and methods increased the injury costs reported in WISQARS Cost of Injury. Researchers and public health professionals can use this information to proficiently communicate the burden of injuries and violence in terms of economic cost.

Monetised estimated quality-adjusted life year (QALY) losses for non-fatal injuries.

BACKGROUND: Quality-adjusted life years (QALYs) provide a means to compare injuries using a common measurement which allows quality of life and duration of life from an injury to be considered. A more comprehensive picture of the economic losses associated with injuries can be found when QALY estimates are combined with medical and work loss costs. This study provides estimates of QALY loss. METHODS: QALY loss estimates were assigned to records in the 2018 National Electronic Injury Surveillance System - All Injury Program. QALY estimates by body region and nature of injury were assigned using a combination of previous research methods. Injuries were rated on six dimensions, which identify a set of discrete qualitative impairments. Additionally, a seventh dimension, work-related disability, was included. QALY loss estimates were produced by intent and mechanism, for all emergency department-treated cases, by two disposition groups. RESULTS: Lifetime QALY losses ranged from 0.0004 to 0.388 for treated and released injuries, and from 0.031 to 3.905 for hospitalised injuries. The 1-year monetary value of QALY losses ranged from $136 to $437 000 among both treated and released and hospitalised injuries. The lifetime monetary value of QALY losses for hospitalised injuries ranged from $16 000 to $2.1 million. CONCLUSIONS: These estimates provide information to improve knowledge about the comprehensive economic burden of injuries; direct cost elements that can be measured through financial transactions do not capture the full cost of an injury. Comprehensive assessment of the long-term cost of injuries, including quality of life losses, is critical to accurately estimate the economic burden of injuries.

State-Level Economic Costs of Fatal Injuries - United States, 2019.

Unintentional and violence-related injury fatalities, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the 10 leading causes of death for all age groups in the United States in 2019.* There were 246,041 injury deaths in 2019 (unintentional injury was the most frequent cause of death after heart disease and cancer) with an economic cost of $2.2 trillion (1). Extending a national analysis (1), CDC examined state-level economic costs of fatal injuries based on medical care costs and the value of statistical life assigned to 2019 injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).† West Virginia had the highest per capita cost ($11,274) from fatal injury, more than twice that of New York, the state with the lowest cost ($4,538). The five areas with the highest per capita total fatal injury costs were West Virginia, New Mexico, Alaska, District of Columbia (DC), and Louisiana; costs were lowest in New York, California, Minnesota, Nebraska, and Texas. All U.S. states face substantial avoidable costs from injury deaths. Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from the CDC's National Center for Injury Prevention and Control.§.

Economic Cost of Injury - United States, 2019.

Unintentional and violence-related injuries, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the top 10 causes of death for all age groups in the United States and caused nearly 27 million nonfatal emergency department (ED) visits in 2019.*,† CDC estimated the economic cost of injuries that occurred in 2019 by assigning costs for medical care, work loss, value of statistical life, and quality of life losses to injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).§ In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses. More than one half of this cost ($2.4 trillion) was among working-aged adults (aged 25-64 years). Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from CDC's National Center for Injury Prevention and Control.¶.

Do out-of-pocket costs influence retention and adherence to medications for opioid use disorder?

BACKGROUND: Availability of medications for opioid use disorder (MOUD) has increased during the past two decades but treatment retention and adherence remain low. This study aimed to measure the impact of out-of-pocket buprenorphine cost on treatment retention and adherence among US commercially insured patients. METHODS: Medical payment records from IBM MarketScan were analyzed for 6,439 adults age 18-64 years with commercial insurance who initiated buprenorphine treatment during January 1, 2016 to June 30, 2017. Regression models analyzed the relationship between patients' average daily out-of-pocket buprenorphine cost and buprenorphine retention (at least 80 % days covered by buprenorphine) at three different thresholds (180, 360, and 540 days) and adherence (the number of days of buprenorphine coverage) within each retention threshold. Models controlled for patient demographic and clinical characteristics including age, sex, presence of other substance use disorders, psychiatric and pain diagnoses, and receipt of prescription medications. RESULTS: A one dollar increase in daily out-of-pocket buprenorphine cost was associated with a 12-14 % decrease in the odds of retention and a 5-8 % increase in the number of days without buprenorphine coverage during each analyzed retention threshold. CONCLUSION: Recent policies have attempted to address supply-side barriers to MOUD treatment. This study highlights patient cost-sharing as a demand-side barrier to MOUD. While the average out-of-pocket buprenorphine cost is lower than two decades ago, this study suggests even at current levels such costs decrease retention and adherence among commercially insured patients. Efforts to address demand-side barriers could help maximize the health and social benefits of buprenorphine-based MOUD.

Assessment of Annual Cost of Substance Use Disorder in US Hospitals.

Importance: A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment. Objective: To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective. Design, Setting, and Participants: This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020. Exposures: International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) principal or secondary SUD diagnosis on the hospital discharge record according to the Clinical Classifications Software categories (disorders related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, and other substances). Main Outcomes and Measures: Annual attributable SUD medical cost in hospitals overall and by substance type (eg, alcohol). The number of encounters (ED and inpatient) with SUD diagnosis (principal or secondary) and the mean cost attributable to SUD per encounter by substance type are also reported. Results: This study examined a total of 124 573 175 hospital ED encounters and 33 648 910 hospital inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Total annual estimated attributable SUD medical cost in hospitals was $13.2 billion. By substance type, the cost ranged from $4 million for inhalant-related disorders to $7.6 billion for alcohol-related disorders. Conclusions and Relevance: This study's results suggest that the cost of effective prevention and treatment may be substantially offset by a reduction in the high direct medical cost of SUD hospital care. The findings of this study may inform the treatment of patients with SUD during hospitalization, which presents a critical opportunity to engage patients who are at high risk for overdose. Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for SUD-related medical costs in hospitals and other health care settings may encourage prevention investment.

Systematic Review of Violence Prevention Economic Evaluations, 2000-2019.

CONTEXT: Health economic evaluations (e.g., cost-effectiveness analysis) can guide the efficient use of resources to improve health outcomes. This study aims to summarize the content and quality of interpersonal violence prevention economic evaluations. EVIDENCE ACQUISITION: In 2020, peer-reviewed journal articles published during 2000-2019 focusing on high-income countries were identified using index terms in multiple databases. Study content, including violence type prevented (e.g., child abuse and neglect), outcome measure (e.g., abusive head trauma clinical diagnosis), intervention type (e.g., education program), study methods, and results were summarized. Studies reporting on selected key methods elements essential for study comparison and public health decision making (e.g., economic perspective, time horizon, discounting, currency year) were assessed. EVIDENCE SYNTHESIS: A total of 26 economic evaluation studies were assessed, most of which reported that assessed interventions yielded good value for money. Physical assault in the community and child abuse and neglect were the most common violence types examined. Studies applied a wide variety of cost estimates to value avoided violence. Less than two thirds of the studies reported all the key methods elements. CONCLUSIONS: Comprehensive data collection on violence averted and intervention costs in experimental settings can increase opportunities to identify interventions that generate long-term value. More comprehensive estimates of the cost of violence can improve opportunities to demonstrate how prevention investment can be offset through avoided future costs. Better adherence to health economic evaluation reporting standards can enhance comparability across studies and may increase the likelihood that economic evidence is included in violence prevention decision making.

Average medical cost of fatal and non-fatal injuries by type in the USA.

OBJECTIVE: To estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type. METHODS: The attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to 30 September 2015. The cost of fatal injuries was the multivariable regression-adjusted average among patients who died in hospital emergency departments (EDs) or inpatient settings as reported in the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample, controlling for demographic (eg, age), clinical (eg, comorbidities) and health insurance (eg, Medicaid) factors. The 1-year attributable cost of non-fatal injuries was assessed among patients with ED-treated injuries using MarketScan medical claims data. Multivariable regression models compared total medical payments (inpatient, outpatient, drugs) among non-fatal injury patients versus matched controls during the year following injury patients' ED visit, controlling for demographic, clinical and insurance factors. All costs are 2015 US dollars. RESULTS: The average medical cost of all fatal injuries was approximately $6880 and $41 570 per ED-based and hospital-based patient, respectively (range by injury type: $4764-$10 289 and $31 912-$95 295). The average attributable 1-year cost of all non-fatal injuries per person initially treated in an ED was approximately $6620 (range by injury type: $1698-$80 172). CONCLUSIONS AND RELEVANCE: Injuries are costly and preventable. Accurate estimates of attributable medical care costs are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.