Death Cost

According to the National Safety Council, the true cost of occupational injuries and deaths to the nation far surpasses the cost incurred from woikers compensation alone. In 2005, the cost was 160.4 billion, which includes wage and productivity losses of 80.0 billion, medical cost of 31.3 billion, and administrative cost of 34.4 billion. It also includes 10.7 billion for such uninsured costs as the money value of time lost by workers other than those with disabling injuries who are directly or indirectly involved in the injuries and the cost to investigate injuries, write up reports, etc. In addition, it includes damages to motor vehicles in work injuries of 1.7 billion and fire losses of 2.3 billion. 

Each and every worker would have to generate goods and service equal to 1100 to offset the cost of work injuries. If a woiker dies on the job, the cost of the death is 1,190,000 while the cost of a disabling itgury is 38,000. 

Accidents are more expensive than most realize because of hidden costs, for example, woikers compensation covers direct costs such as medical and indemnity payment for an injured or ill worker. However, the cost to train and compensate a replacanent worker, repair damaged property, investigate the accident and implement corrective action, and to maintain insurance coverage will not be covered. Even less apparent are the costs related to schedule delays, added administrative time, lower morale, increased absenteeism, and poorer customer relations. These are all examples of indirect cost. 

Studies have shown that the ratio of indirect cost to direct cost varies widely from 20 1 to 1 1. OSH A has shown that the smaller the cost of the accident the greater the direct to indirect cost ratio (see Table 9.7). Over many years I have always used a ballpark figure of around 5-10 for indirect cost to direct cost. There is little doubt that indirect cost can mount up quickly. 

Let us use some common figures that may help to put this into perspective. To pay for an accident with a total cost of 1000  

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CDC reports melanoma deaths cost U.S. 3.5 billion per year www.ishn.com/health... 

Patient safety has become a major concern around the globe, because it results in millions of deaths costing billions of dollars each year to the world economy. In the United States alone, preventable adverse safety-related events cause 44,000-98,000 deaths and a very large number of injuries annually costing 17-29 billion to its economy each year [1]. 

Each year a vast sum of money is spent on health care around the globe, and patient safety has become a serious global public health issue because it results in millions of deaths costing billions of dollars to the world economy each year. As per the World Health Organization, in developed countries alone as many as 1 in 10 patients is harmed while receiving hospital care due to a range of errors or adverse events. 

The survival of patients with malignant obstructive jaundice after endoscopic palliation is similar to that following surgical palliative approaches. However, from initial diagnosis to death, costs associated with endoscopy have been reported to be 50%-75% lower... 

Replacement cost x floor area x mean damage index Unit contents cost x floor area x mean damage index Rental rate x gross leasable area x loss of function Rental rate x gross leasable area x down time Minor injury cost per person x floor area x occupancy rate x expected minor injury rate Serious injury cost per person x floor area x occupancy rate x expected serious injury rate Death cost per person x floor area x occupancy rate x expected death rate... 

Some scientific studies indicate that the gam in performance obtained through the use of anabolic steroids is small This may be a case though in which the anecdotal evidence of the athletes may be closer to the mark than the scientific studies The scientific studies are done under ethical conditions in which patients are treated with prescription level doses of steroids A 240 pound offensive tackle ( too small by todays standards) may take several ana bolic steroids at a time at 10-20 times their pre scribed doses in order to weigh the 280 pounds he (or his coach) feels is necessary The price athletes pay for gams in size and strength can be enormous This price includes emotional costs (friendships lost because of heightened aggressiveness) sterility testicular atro phy (the testes cease to function once the body starts to obtain a sufficient supply of testosterone like steroids from outside) and increased risk of prema ture death from liver cancer or heart disease... 

Each year, Americans report over three million fires leading to 29,000 injuries and 4,500 deaths (1). The direct property losses exceed 8 biUion (1) and the total annual cost to our society has been estimated at over 100 biUion (2). Personal losses occur mosdy in residences where furniture, wall coverings, and clothes are frequently the fuel. Large financial losses occur in commercial stmctures such as office buildings and warehouses. Fires also occur in airplanes, buses, and trains. 

Minimization of impingement risks focuses on site-specific analyses of potentially vulnerable species and selection of engineering designs which, within acceptable cost limits, keep impingement deaths low. 

Rotavirus. Rotavims causes infant diarrhea, a disease which has major socio-economic impact. In developing countries it is the major cause of death in infants worldwide, causing up to 870,000 deaths per year. In the United States, diarrhea is stiU a primary cause of physician visits and hospitalization, although the mortaUty rate is relatively low. Studies have estimated a substantial cost benefit for a vaccination program in the United States (67—69). Two membrane proteins (VP4 and VP7) of the vims have been identified as protective epitopes and most vaccine development programs are based on these two proteins as antigens. Both Hve attenuated vaccines and subunit vaccines are being developed (68). 

Specialty plants. These plants are capable of producing small amounts of a variety of products. Such plants are common in fine chemicals, pharmaceutic s, foods, and so on. In specialty plants, the margins are usually high, so factors such as energy costs are important but not life-and-death issues. As the production amounts are relatively small, it is not economically feasible to dedicate processing equipment to the manufac ture of only one product. Instead, batch processing is utilized so that several products (perhaps hundreds) can be manufactured with the same process equipment. The key issue in such plants is to manufacture consistently each product in accordance with its specifications. 

Table 11.4-2 shows risk reduction measures and their impact on public risk, their cost, and the cost per death averted. From this table, with the exception of the last one (because of high cost), the measures are practical for implementation. 

Answer Given l,000/rem and 10,000 rem/death, the cost of a human death from radiation is 10 M. 

Answer Using the cost of a life for radiation, the cost was 3El 1. The expenditure rate was lElO/minute or 10 billion dollars/minute. Clearly if soldier lives were valued the same as radiation death, no government could afford to go to war,... 

Bozette et al. (2001) examined expenditures for the care of adult HIV-infected patients since the introduction of highly active antiretroviral therapy. They interviewed a representative random sample of 2,864 patients in early 1996 and followed them for up to 36 months. They estimated the average expenditure per patient per month on the basis of self-reported information. According to their calculations, the mean expenditure was US 1,792 per patient per month at base hne in early 1996, but it decbned to US 1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from US 20,300 per patient (1996) to US 18,300 (1998). 

Hanvelt et al. (1994) estimated the nationwide indirect costs of mortality due to HIV/AIDS in Canada. A descriptive, population-based economic evaluation study was conducted. Data from Statistics Canada were used, which contained information about aU men aged 25-64 years for whom HIV/AIDS or another selected disease was listed as the underlying cause of death from 1987 to 1991. Based on the human capital approach, the present value of future earnings lost for men was calculated. The estimated total loss from 1987 to 1991 was US 2.11 billion, with an average cost of US 558,000 per death associated with HIV/AIDS. Future production loss due to HIV/AIDS was more than double during the period 1987 to 1991, from US 0.27 to US 0.60 billion. A more comprehensive update of this smdy was presented by Hanvelt et al. (1996). The same database and the same data section but for the calendar years 1987-1993 was used. The indirect cost of future production due to HIV/AIDS in Canada based on the human capital approach for that period was estimated to be US 3.28 billion. The authors also calculated the willingness-to-pay to prevent premature death due to HIV/AIDS, which was estimated based on... 

An effective HE or cost-effectiveness analysis is designed to answer certain questions, such as Is the treatment effective What will it cost and How do the gains compare with the costs By combining answers to all of these questions, the technique helps decision makers weigh the factors, compare alternative treatments, and decide which treatments are most appropriate for specific situations. Typically, one chooses the option with the least cost per unit of measure gained the results are represented by the ratio of cost to effectiveness (C E). With this type of analysis, called a cost-effectiveness analysis (CEA), various disease end points that are affected by therapy (risk markers, disease severity, death) can be assessed by corresponding indexes of therapeutic outcome (mmHg blood pressure reduction, hospitalizations averted, life years saved, respectively). It is beyond the scope of this chapter to elaborate further on principles of cost-effectiveness analyses. A number of references are available for this purpose [11-13]. 

Diabetes continues to be a major cause of excessive morbidity, severe disability and premature death in Western populations. In developed countries, the cost of diabetes to society may be estimated to be as high as 5% of the total health costs, much of which relates to the chronic vascular complications of this disorder (Williams, 1991). The vascular lesion in diabetes consists of (1) microangiopathy, distinguished by thickening of capillary basement membranes resulting in increased vascular permeability, which is clinically manifested as diabetic retinopathy (Fig. 12.1a) and/or nephropathy (Fig. 12.1b), and (2) macroangiopathy (Fig. 12.2),... 

Hypertension is widely prevalent and accounts for significant morbidity and mortality, as well as billions of dollars in direct and indirect costs. Worldwide prevalence of hypertension is estimated to include 1 billion individuals. There are an estimated 7 million deaths per year that may be related to the diagnosis of hypertension.4 The prevalence of hypertension in the United States is estimated to include 65 million individuals and accounts for an estimated 59.7 billion dollars annually in direct and indirect costs.1... 

Secondary prevention of death, reinfarction, and stroke is more cost effective than primary prevention of coronary heart disease events. 

Because the costs for chronic preventative pharmacotherapy are the same for primary and secondary prevention, while the risk of events is higher with secondary prevention, secondary prevention is more cost effective than primary prevention of CHD. Pharmacotherapy demonstrating cost effectiveness to prevent death in the ACS and post-MI patient includes fibrinolytics ( 2,000 to 33,000 cost per year of life saved), aspirin, glycoprotein Ilb/IIIa receptor blockers ( 13,700 to 16,500 per year of life added), (3-blockers (less than 5,000 to 15,000 cost per year of life saved), ACE inhibitors ( 3,000 to 5,000 cost per year of life saved), eplerenone ( 15,300 to 32,400 per year of life gained), statins ( 4,500 to 9,500 per year of life saved) and gemfibrozil ( 17,000 per year of life saved).49-58 Because cost-effectiveness ratios of less than 50,000 per added life-year are considered economically attractive from a societal perspective,49 pharmacotherapy described above for ACS and secondary prevention are standards of care because of their efficacy and cost attractiveness to payors. 

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