The cost of decompression illness: the case of lobster and sea cucumber fishery in Yucatan, Mexico.

Diving fisheries are an important source of income and protein for many coastal communities around the world. However, these fisheries are also the cause of both fatal and non-fatal injuries. The aim of this study is to estimate the costs of decompression sickness (DCS) in the diving small-scale fisheries that target benthic resources in the Yucatan, Mexico. The DCS cases that occurred during three fishing seasons for sea cucumber (Isostichopus badionotus) and one for spiny lobster (Panulirus argus) were used to calculate the direct medical costs. The catch data during the same fishing seasons were used to calculate the potential losses caused by disability as indirect costs. In the three years (from 2013 to 2016) the total number of fishermen treated in the region numbered 282; 116 during lobster fishing and 166 during sea cucumber season. The direct medical costs were estimated to be USD $120,269; the temporary loss of income in USD $724,377; and the permanent loss of income was USD $737,053. Considering the direct and indirect costs, the social costs of diving in both small-scale fisheries was USD $1,614,121. This is a first approach to estimate the cost of the use of diving in fisheries for the health services but for the fishing communities as well. Furthermore, this is an important first step on the road to a full economic evaluation of the benthic fisheries in order to improve their management.

Decision analysis in aerospace medicine: costs and benefits of a hyperbaric facility in space.

INTRODUCTION: Assembly and maintenance of the International Space Station (ISS) requires an unprecedented number of spacewalks, which expose astronauts to the risk of decompression sickness (DCS). We illustrate the use of decision analysis to compare a hyperbaric oxygen (HBO) chamber to currently available therapy for DCS treatment on the ISS. METHODS: A decision-analytic model that simulates events over the lifespan of the ISS was constructed. Inputs to the model for probabilities, costs, and measures of morbidity and mortality were derived from a variety of sources, including a systematic literature review and an iterative consultation process with personnel at the Canadian Space Agency and the National Aeronautics and Space Administration (NASA). The decision model was analyzed using the methods of Monte-Carlo simulation and expected value calculation. Main outcome measures included the present value of costs and quality adjusted life years (QALYs), and the cumulative probability of mission-related events over the life cycle of the ISS. Sensitivity analysis was performed. RESULTS: The HBO chamber strategy is associated with a mean cost of -12.5 million dollarsw (a net cost saving of 12.5 million dollars) with a 95% CI (-112.8 million dollars, 51.3 million dollars). An HBO chamber reduces the likelihood of a premature shuttle return and a premature Soyuz return by 8% and 3%, respectively. The result is sensitive to the lifespan of the ISS. CONCLUSIONS: At a 50 million dollars cost, an HBO chamber is likely, though not certain, to result in cost savings. Decision analysis is a useful tool for use in priority setting in aerospace medicine.