Infectious disease outbreaks can have a significant impact on healthcare resources and are disruptive to routine healthcare programs and services. There is very little literature on the economic burden of infectious disease outbreaks; thus, this research attempts to provide insight into the healthcare resources used to contain a mumps outbreak. The Nova Scotia 2007 mumps outbreak provides an opportunity to produce a costing framework to capture the economic burden an outbreak has on the Nova Scotia healthcare system. The costing framework for this study used an accounting model to costing; in particular, it used an activity-based costing approach. The total mumps outbreak cost is estimated at $2,478,500 or $3,511 per mumps case. Given the significant impact an infectious disease outbreak has on healthcare resources, more economic evaluations should be done to help guide policies around infectious disease prevention strategies, and to maximize the allocation of healthcare resources.

Background: Food allergy, an abnormal immunologic response to food protein, has an estimated prevalence of 6% in young children and 3.7% in adults in the U.S. The only proven therapy for food allergy is strict elimination of the offending allergens. As a result, caregivers and patients could experience constant anxiety and stress that affects their quality of life. Additionally, food allergy can lead to significant economic impact on the health care system, since severe reactions often lead to ED visits and hospitalizations. Objectives: The first major objective was to determine the economic burden of Food Allergy and Anaphylaxis (FAA) patients in the U.S. by estimating the direct medical and indirect costs. The second principal objective involved assessing the Health Related Quality of Life (HRQL) of food allergic patients by measuring their health utilities and disease specific quality of life. Methods: Economic burden was estimated by measuring certain direct medical and indirect costs from a societal perspective. Costs were estimated using a bottom-up approach -- calculating the average cost of illness per patient and multiplying it by reported prevalence estimates. FAA patients with an emergency department (ED) visit, office based physician visit, outpatient department visit, and hospital admission were identified from a list of federally administered databases using ICD-9 codes. Sensitivity analyses were conducted to measure the robustness of the estimates. The cross-sectional HRQL study measured health utilities in food allergic adults and children, and quality of life in allergic adults using EQ-5D and FAQL-AF questionnaires respectively. These questionnaires were administered in an online survey format. Regression models were specified to explore the deviations in HRQL scores between patients with different disease related characteristics. Results: The findings reveal that for a given year (2007), direct medical costs worth $225 million and indirect costs worth $115 million were incurred. Owing to the irregularities in the reporting and diagnosis of food allergy, these values might be an underestimation. Simulations from probabilistic sensitivity analysis generated mean direct medical costs of $307 million and indirect costs of $203 million. Survey responses were collected online for eight months, during which 45 adults and 94 parents (acting as proxy for their food allergic child) responded. Adults reported a mean utility of 0.874 compared to 0.918 for children. Gender, number of food allergies and frequency of carrying epinephrine device had significant impacts on HRQL scores. An effect size of 0.003 was estimated comparing health utilities of food allergic adults with the general U.S. population. Conclusions: This was the first research to examine economic burden of FAA, and elucidate health utilities for food allergic patients. A large proportion of costs were incurred due to ambulatory visits. Effect size calculation revealed that health utilities of food allergic patients were very similar to the general U.S. population.

Introduction The main objectives of this study were: 1) to examine the prevalence and characteristics of opioid exposures, 2) to estimate the economic costs associated with opioid poisonings, and 3) to examine the characteristics associated with opioid poisoning-related health care resource use (HCRU) and costs in children. Methods Data from the National Poison Data System from January 1, 2010 to December 31, 2014 were utilized to examine the prevalence and characteristics of opioid exposures and poisonings in children <18 years. Economic costs were estimated using the 2012 Nationwide Emergency Department Sample, Kids’ Inpatient Database, Multiple Cause-of-Death file and other published sources, applying a societal perspective. Direct costs included costs associated with ED visits, hospitalizations and ambulance transports. Indirect cost included productivity costs due to caregivers’ absenteeism and premature mortality among children. Results There were a total of 83,418 pediatric opioid exposures and nearly half of them resulted in poisoning. The epidemiology of opioid exposures differed considerably by age. Opioid exposures were more prevalent and mainly accidental in young children. Exposures in adolescents were more likely to be intentional and severe. The total economic costs of pediatric opioid poisonings in the United States were calculated at $230.8 million in 2012. Total direct costs were estimated to be over $21.1 million. Total productivity costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Conclusions Opioid exposures and poisonings in children continue to occur and impose an economic burden on the society.

Objectives: Evaluate the association of cancer on net worth, consumer debt, mortgage debt, home equity and changes in retirement trends. Methods: Data from the Health and Retirement Study from 1998-2010 was used. Persons had to have a diagnosis of cancer. The index date was the corresponding HRS wave of the year of the first diagnosis of cancer. The pre-index date was 2 years and a 2-year and 4-year post index was observed. Primary outcomes of interest were zero/negative net worth and net worth. Multiple logistic regression was used to test for the association between demographic, economic, human capital, and cancer-related variables on outcomes. Generalized linear models were conducted to assess the association of cancer on net worth, consumer debt, mortgage debt, and home equity. Multinomial logistic regression was performed to assess the association of cancer on retirement. Results: A total of 6,055,110 individuals (weighted) qualified. The majority of patients in this sample were male (53.8%), non-Hispanic (95.5%), and white (90.3%). Marital status (p<0.05), alcohol consumption (p=0.046), hypertension (p = 0.034), private insurance (p=0.001), cancer status (p<0.001), and cancer treatment (p=0.022) were significant predictors of zero/negative net worth 4-years after cancer diagnosis. Patients receiving treatment for their cancer were 71% more likely to have consumer debt 4-years post diagnosis (p=0.006). Patients who reported their cancer improving 4-years post diagnosis were significantly less likely (p=0.008) to have consumer debt (OR=0.59; 95%CI: 0.41-0.87). Cancer treatment and cancer status were significant predictors of mortgage debt (p<0.001 and 0.024, respectively). For individuals whose cancer either improved (OR=1.46; 95%CI: 1.04-2.06) or worsened (OR=4.09; 95%CI: 1.38-12.15), both groups were significantly more likely (p=0.030 and 0.011, respectively) to have home equity 4-years post diagnosis. Cancer status was a significant predictor of individuals transitioning from working to retired (p=0.022).Conclusion: This nationally representative investigation of 6.1 million patients over 50 years of age with cancer found that approximately 65% of cancer patients reported zero/negative net worth of cancer and almost 45% of cancer patients reported consumer debt four-years post diagnosis. Cancer-related characteristics explain a significant amount of the change in net worth four-years post diagnosis of cancer.

Background: Tuberculosis (TB) remains a salient public health issue along the U.S./Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region. Methods: Retrospective study of data extracted from medical charts (n = 439) from Yuma County Health Department (YCHD) (n = 160) and Centro de Salud San Luis Rio Colorado (n = 279). Patients currently accessing TB treatment at either facility were excluded from the study. Chi-square, unadjusted odds ratios, and logistic regression were utilized to identify characteristics associated with successful TB treatment in this population. Findings: The study population was predominantly male (n = 327). Females were more likely to complete TB treatment (OR = 3.71). The absence of drug use and/or the absence of an HIV positive diagnosis were found to be predictors of TB treatment completion across both clinical sites. Forty-four percent (43.59%) (n = 85) TB patients treated at CDS San Luis did not complete treatment versus 40.35% (n = 49) of TB patients who did not complete treatment at YCHD. Moving from the area or being deported was the highest category (20.78%) for incomplete TB treatment in the population (n = 64) across both clinical sites.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes. / New York University Abu Dhabi

It is paramount that an accurate assessment of the impact of a cancer diagnosis is available with which to plan future resource allocation and to highlight the area to direct future policy initiatives. In the second chapter I take a modelling approach to estimate the economic burden of bladder cancer due occupational exposure. Using a multi-stage Markov model, I estimate direct, indirect, and intangible lifetime costs of bladder cancer starting in the year 2011. The results of this analysis indicate that there is a substantial economic burden associated with occupational bladder cancer. Of the three components that make up the total economic costs, intangible costs represent the largest proportion, followed by indirect and direct costs. In the third chapter, I use a data set created via a linkage of several administrative data resources to estimate the relationship between cancer diagnosis and annual labour market earnings. Using the Mahalanobis' distance and propensity score matching combined with a difference-in-difference regression, I isolate the impact of cancer diagnosis on labour market earnings of cancer survivors by comparison to their peers without cancer. There are two conclusions that can be derived from the results. First, I found that cancer survivors recover a fraction of their labour market earnings over time as they are further removed from the time of the cancer diagnosis. Secondly, I found the heterogeneous effects of cancer where most cancer survivors showed a persistent loss of labour market earnings except breast, cervix, and skin cancer survivors in the less-active age group. In the fourth chapter I examine the impact of cancer on health using three commonly used health indicators: life expectancy, Health Utility Index, and health-adjusted life expectancy. Specifically, I decomposed the differences between individuals with and without cancer in above-mentioned indicators by age and cancer type—considering all cancer types, then specifically breast, colorectal and prostate cancers. The results of the study indicate the heterogeneous effects of cancer on health outcomes and provide a repository of health outcome information that other researchers and policymakers can use. / Thesis / Doctor of Philosophy (PhD) / In 2017, there were approximately 206,200 new cancer diagnoses in Canada, and 1 in 2 Canadians are currently expected to develop cancer in their lifetime. The chances are that most Canadians may know someone—likely more than one person—who has been afflicted with cancer. As more Canadians are diagnosed with cancer and survive, researchers are increasingly trying to understand and describe the short- and longer-term impact of cancer on health and social role engagement (particularly paid work) of afflicted individual, with the intent of identifying ways to minimize adverse outcomes. The following chapters investigate the impact of a cancer diagnosis on annual labour market earnings, health, and the aggregation of these and other impacts on the societal economic burden. Chapter 1 sets the context for the entire thesis and draw out the overall objectives and motivations of the work. In Chapter 2 I conduct a comprehensive costing evaluation to estimate the economic burden of occupational cancer, taking a societal perspective, and provide a detailed breakdown of items that contribute to the economic burdens of cancer. In Chapter 3 I estimate the change in labour market earnings due to cancer diagnosis over a period of 5 years to uncover the heterogeneous effects of cancer type on labour market earnings. Finally, in Chapter 4 I estimate the impact of cancer on health using three different health indicators. In Chapter 5 I summarize the findings and contributions of each study.

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La dengue est une préoccupation mondiale majeure en santé publique, touchant principalement les jeunes enfants en Asie du sud est. Les vaccins contre la dengue sont actuellement en développement. Des études coût-efficacité seront nécessaires en cas d'introduction d'un nouveau vaccin. Pour cela, il est indispensable d’obtenir des informations sur le coût économique lié à la dengue (qui sont relativement rares) et des données précises sur l'incidence de la maladie, ceci afin de fournir des estimations solides quant à l'importance de la dengue dans les régions endémiques.Ce travail de thèse propose une approche méthodologique par laquelle le Ministère de la Santé devrait envisager lors de l'évaluation de la pertinence et de la faisabilité de l'adoption d’un vaccin contre la dengue par les programmes de nationaux de vaccination, particulièrement dans les pays en voie de développement ; le Cambodge par exemple. Nous avons mis en place des études prospectives d'incidence de la dengue sur plusieurs années, réalisées dans la population générale, incluant un large éventail de groupes d'âge. Les résultats de ces études ont été comparés avec les données de surveillance nationale réunis dans la même région en calculant des facteurs de multiplication afin d’estimer la sous-déclaration. D'autres études de coûts de la maladie ont été menées pour estimer le poids financier la dengue sur plusieurs années et d'identifier les groupes vulnérables. Cette approche a également permis de mieux comprendre l'épidémiologie de la dengue dans le pays, dont certaines caractéristiques sont nécessaires pour évaluer la faisabilité de l'introduction d’un nouveau vaccin contre la dengue. Les résultats rapportés dans cette thèse vont permettre (1) d’initier à partir des données cambodgiennes des simulations de coût-efficacité à partir des caractéristiques attendues du vaccin et (2) de développer un modèle dynamique afin de permettre aux autorités nationales d'analyser les études de coût-efficacité en tenant compte des spécificités immunologiques et épidémiologiques des pays concernés. Si un vaccin efficace et fiable est disponible à un prix abordable, son adoption par le programme national de vaccination serait probablement rentable pour le Cambodge mais répondrait surtout à un problème d'inéquité sociale. / Dengue is a major public health concern worldwide, particularly in young children in Southeast Asia. Dengue vaccines are currently in development and policymakers need appropriate economic studies to determine their potential financial and public health impact. Alongside economic assessment, accurate disease incidence data are required to provide robust estimates of disease burden across the regions where dengue is endemic. This thesis proposes a methodological approach by which the Ministry of Health should consider when assessing feasibility of adoption dengue vaccines, with specific reference to developing country settings, e.g. Cambodia. We implemented prospective dengue incidence studies over several years, performed in a general population and include a wide range of ages. The results of these studies were compared with national surveillance data gathered in the same region by calculating multiplication factors to estimate underreporting on several years. Additional prospective cost of illness study was conducted to generate accurate economic burden of disease estimates over several years and identify vulnerable groups. This strategy also allowed better understanding of the epidemiology of dengue in Cambodia, of which some characteristics are needed to evaluate the feasibility of introducing dengue vaccine. Designing cost-effectiveness studies before a vaccine has been fully evaluated requires assumptions about variables such as efficacy and effectiveness, dosage and costs. Our next step will be to determine the threshold price – sensitivity analyses - for a vaccine to be cost-effective rather than assigning a specific cost, because it is difficult to predict cost for a vaccine that has not been marketed. Should this vaccine be safe and affordable enough, the adoption of the new vaccine into a National Immunization Programme would probably be cost-effective but, above all, a matter of social equity.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22382号 / 社医博第104号 / 新制||社||医11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 髙橋 良輔, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM