Cost of tobacco-related diseases, including passive smoking, in Hong Kong

Background

Costs of tobacco‐related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking.

Aim

To estimate the health‐related costs of tobacco from both active and passive smoking.

Methods

Using local data, we estimated active and passive smoking‐attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US$1.3 million for a life lost.

Results

In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US$532 million for active smoking and US$156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US$9.4 billion.

Conclusion

The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke‐free areas in the Asia Pacific Region and elsewhere.     

Economic cost of illness due to Escherichia coli O157 infections in the United States

The Centers for Disease Control and Prevention (CDC) has estimated that Shiga toxin-producing Escherichia coli O157 (0157 STEC) infections cause 73,000 illnesses annually in the United States, resulting in more than 2,000 hospitalizations and 60 deaths. In this study, the economic cost of illness due to O157 STEC infections transmitted by food or other means was estimated based on the CDC estimate of annual cases and newly available data from the Foodborne Diseases Active Surveillance Network (FoodNet) of the CDC Emerging Infections Program. The annual cost of illness due to O157 STEC was $405 million (in 2003 dollars), including $370 million for premature deaths, $30 million for medical care, and $5 million in lost productivity. The average cost per case varied greatly by severity of illness, ranging from $26 for an individual who did not obtain medical care to $6.2 million for a patient who died from hemolytic uremic syndrome. The high cost of illness due to O157 STEC infections suggests that additional efforts to control this pathogen might be warranted.     

Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison

Objective

To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993.

Methods

The number of deaths, years of potential life lost (YPLL), direct medical and indirect costs caused by active cigarette smoking in Germany in 2003 is estimated from a societal perspective. The method is similar to that applied by Welte et al, who estimated the cost of smoking in Germany in 1993. Therefore, a direct comparison of the results was possible. Methodological and data differences between these two publications and their effect on the results are analysed.

Results

In 2003, 114 647 deaths and 1.6 million YPLL were attributable to smoking. Total costs were €21.0 billion, with €7.5 billion for acute hospital care, inpatient rehabilitation care, ambulatory care and prescribed drugs; €4.7 billion for the indirect costs of mortality; and €8.8 billion for costs due to work loss days and early retirement. From 1993 to 2003, the proportionate mortality attributable to smoking remained relatively stable, rising from 13.0% to 13.4%. The smoking‐attributable deaths in men is lowered by 13.7% whereas that in women increased by 45.3%. Total real direct costs rose by 35.8%, and total real indirect costs declined by 7.1%, rendering an increase of 4.7% to real total costs. Accountable factors are changes in cigarette smoking prevalence and in disease‐specific mortality and morbidity, as well as a rise in general healthcare expenditure.

Conclusions

Despite the growing knowledge about the hazards of smoking, the smoking‐attributable costs increased in Germany. Further, female mortality attributable to smoking is much higher than it was in 1993.As a result of the devastating health consequences of smoking, many countries have implemented anti‐smoking measures. For example, Ireland and Italy banned smoking in all public buildings and at all workplaces, including pubs and restaurants. Several publications have shown that Germany is still rather friendly to the tobacco industry.¹ This is also supported by recent decisions not to implement a smoking ban or to prohibit smoking in all public places. However, Germany increased the tax on tobacco products three times since 2004, which decreased cigarette sales and smoking prevalence in the age group 12–17 years.^2,3The first cost‐of‐smoking study for Germany used 1993 as the reference year,⁴ and was published by some of us. Since then, three other studies have been published: one is by Ruff et al,⁵ which cannot be used for comparison because of a lack of methodological transparency, and two by Wegner et al,^6,7 which considered only indirect costs. Thus, costs of smoking can be compared with only the first study.This study presents the most recent estimate for both direct and indirect costs of cigarette smoking in Germany, based on the latest available data and referring to the year 2003. As a similar method was applied, costs of smoking can be directly compared between 1993 and 2003.     

Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan

Objective

To estimate the lifetime financial burden on Taiwan''s national health insurance (NHI) system, life expectancy and years of life expectancy lost (YLEL) attributable to smoking from major smoking related diseases.

Methods

10 major smoking related diseases (seven cancers, stroke, acute myocardial infarction and chronic obstructive pulmonary disease) were selected for this study. A survival analysis was conducted on linked cohorts from the National Death Registry database and the National Cancer Registry (NCR) and patients at the National Taiwan University Hospital (NTUH). Estimation of the smoking attributable fraction (SAF) for the study diseases was undertaken by combining the relative risks of smokers against non‐smokers and the prevalence of smoking in Taiwan. The YLEL attributable to smoking was calculated for the study diseases by combining the survival analysis results, the SAF and the annual incidences of each disease. The lifetime medical expenditure for the study diseases was estimated by integrating the survival curve and the mean annual medical costs calculated from NHI reimbursement records.

Results

There were 241 280 incidents of the 10 study diseases in 2001, of which about 53 648 cases (22.2%) were attributable to smoking, with a total YLEL of 191 313 at an average of about 3.6 YLEL per case. For each case, the average survival time was about 10.2 years. Under two different annual discount rates, the total lifetime financial burden on the NHI was estimated at between $291 million (£147 million; €216 million) (3% discount) and $336 million (1% discount) for all diseases attributable to smoking in 2001, accounting for about 24.6% of the total estimated lifetime medical expenditure for all incidents of the 10 study diseases.

Conclusions

Smoking places tremendous financial and health burdens upon both society and individuals. A much more stringent tobacco control strategy is needed to curb the damage from smoking.     

Economic burden of smoking in Korea

Objective: To support tobacco control policies in Korea by providing the estimated annual economic burden attributed to cigarette smoking.

Methods: The following two different approaches were used to estimate the cost: "disease specific" and "all causes". In the disease specific approach, we focused on estimating direct and indirect costs involved in treatments of cardiovascular, respiratory, and gastrointestinal diseases, and cancer as a result of smoking, by using an epidemiologic approach—the population attributable risk (PAR). To compute PAR, the relative risks of smoking in terms of physician visits, hospital admission, and death were estimated using the Cox proportional hazard model. In the all causes approach, we examined the differences in direct and indirect costs between smokers and non-smokers for all conditions and types of disease. The major data source was the Korea Medical Insurance Corporation cohort study, which had complete records of smoking status as of 1992 for 115 682 male and 67 932 female insured workers.

Results: By the disease specific approach, the estimated costs attributable to smoking in 1998 in Korea ranged from US$2269.42 million ($4.89 million per 100 000 population; 0.59% of gross domestic product (GDP)) to $2956.75 million ($6.37 million; 0.78% of GDP). The all causes approach yielded a minimum cost of $3154.75 million ($6.79 million; 0.82% GDP) and a maximum of $4580.25 million ($9.86 million; 1.19% GDP).

Conclusion: The study confirms that smoking places a substantial economic burden on Korean society. In light of this, our study provides evidence for a strong need to develop a national policy to effectively control tobacco consumption in Korea.

     

Economic burden from health losses due to foodborne illness in the United States

The Centers for Disease Control and Prevention (CDC) recently revised their estimates for the annual number of foodborne illnesses; 48 million Americans suffer from domestically acquired foodborne illness associated with 31 identified pathogens and a broad category of unspecified agents. Consequently, economic studies based on the previous estimates are now obsolete. This study was conducted to provide improved and updated estimates of the cost of foodborne illness by adding a replication of the 2011 CDC model to existing cost-of-illness models. The basic cost-of-illness model includes economic estimates for medical costs, productivity losses, and illness-related mortality (based on hedonic value-of-statistical-life studies). The enhanced cost-of-illness model replaces the productivity loss estimates with a more inclusive pain, suffering, and functional disability measure based on monetized quality-adjusted life year estimates. Costs are estimated for each pathogen and a broader class of unknown pathogens. The addition of updated cost data and improvements to methodology enhanced the performance of each existing economic model. Uncertainty in these models was characterized using Monte Carlo simulations in @Risk version 5.5. With this model, the average cost per case of foodborne illness was $1,626 (90% credible interval [CI], $607 to $3,073) for the enhanced cost-of-illness model and $1,068 (90% CI, $683 to $1,646) for the basic model. The resulting aggregated annual cost of illness was $77.7 billion (90% CI, $28.6 to $144.6 billion) and $51.0 billion (90% CI, $31.2 to $76.1 billion) for the enhanced and basic models, respectively.     

Costs of acute bacterial foodborne disease in Canada and the United States

Bacterial foodborne disease is increasing in industrialized as well as developing countries. For Canada and the United States many millions of cases are believed to occur each year, based on extrapolations of survey data, human enteric isolations and reported foodborne disease cases. The economic impact of such a large number is probably in billions of dollars but the precise figure is difficult to calculate. Medical costs and lost income are easier to determine than losses to food companies, legal awards and settlements, value of lost leisure time, pain, grief, suffering and death. The evaluation of costs at the national level for Canada and the United States based on all available costs for 61 incidents showed that company losses and legal action are much higher than medical/hospitalization expenses, lost income or investigational costs. It was reckoned that on an annual basis an estimated 1 million cases of acute bacterial foodborne illness in Canada cost nearly $1.1 billion and 5.5 million cases in the United States cost nearly $7 billion. The value of deaths was a major contributor to the overall costs especially for diseases like listeriosis, salmonellosis, Vibrio infections, and haemorrhagic colitis. Salmonellosis is the economically most important disease because it affects all parts of the food system, unlike typhoid fever and botulism, which are largely controlled by public health authorities and the food industry.     

Regional, disease specific patterns of smoking-attributable mortality in 2000

Background: Smoking has been causally associated with increased mortality from several diseases, and has increased considerably in many developing countries in the past few decades. Mortality attributable to smoking in the year 2000 was estimated for adult males and females, including estimates by age and for specific diseases in 14 epidemiological subregions of the world.

Methods: Lung cancer mortality was used as an indirect marker of the accumulated hazard of smoking. Never-smoker lung cancer mortality was estimated based on the household use of coal with poor ventilation. Estimates of mortality caused by smoking were made for lung cancer, upper aerodigestive cancer, all other cancers, chronic obstructive pulmonary disease (COPD), other respiratory diseases, cardiovascular diseases, and selected other medical causes. Estimates were limited to ages 30 years and above.

Results: In 2000, an estimated 4.83 million premature deaths in the world were attributable to smoking, 2.41 million in developing countries and 2.43 million in industrialised countries. There were 3.84 million male deaths and 1.00 million female deaths attributable to smoking. 2.69 million smoking attributable deaths were between the ages of 30–69 years, and 2.14 million were 70 years of age and above. The leading causes of death from smoking in industrialised regions were cardiovascular diseases (1.02 million deaths), lung cancer (0.52 million deaths), and COPD (0.31 million deaths), and in the developing world cardiovascular diseases (0.67 million deaths), COPD (0.65 million deaths), and lung cancer (0.33 million deaths). The share of male and female deaths and younger and older adult deaths, and of various diseases in total smoking attributable deaths exhibited large inter-regional heterogeneity, especially in the developing world.

Conclusions: Smoking was an important cause of global mortality in 2000, affecting a large number of diseases. Age, sex, and disease patterns of smoking-caused mortality varied greatly across regions, due to both historical and current smoking patterns, and the presence of other risk factors that affect background mortality from specific diseases.

     

The costs of smoking in Vietnam: the case of inpatient care

Objective

To estimate the social costs of smoking related to inpatient care in Vietnam using 2005 data.

Design

The cost of illness as a result of hospitalisation for three major smoking‐related diseases combined with the prevalence‐based approach to obtain the costs of smoking in Vietnam for inpatient care.

Main outcome measure

Smoking‐attributable costs of inpatient care for lung cancer, chronic obstructive pulmonary disease (COPD), and ischaemic heart disease.

Results

The total cost of inpatient health care caused by smoking in Vietnam reached at least 1 161 829 million Vietnamese dollars ($VN) (or $US77.5 million) in 2005. This represents about 0.22% of Vietnam gross domestic product (GDP) and 4.3% of total healthcare expenditure. The majority of these expenses are related to COPD treatment ($VN1 033 541 million or $US68.9 million per year) followed by lung cancer ($VN78 143 million, or $US5.2 million per year) and ischaemic disease ($VN50 145 million, or $US3.3 million per year). The government directly finances about 51% of these costs. The rest is financed either by households (34%) or by the insurance sector (15%).

Conclusions

The social costs of smoking in Vietnam as the percentage of GDP is lower compared to estimates from high‐income countries. The true costs would be substantially higher if all smoking‐related diseases, outpatient care and mortality‐related costs are included. More research is needed to augment the estimates presented in this paper.     

Costs of employee smoking in the workplace in Scotland

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.     

Cost effectiveness of a community based research project to help women quit smoking

Objective: To estimate the cost effectiveness of a four year, multifaceted, community based research project shown previously to help women quit smoking.

Design: A quasi-experimental matched control design.

Setting: Two counties in Vermont and two in New Hampshire, USA.

Subjects: Women aged 18–64 years.

Methods: Costs were the grant related expenditures converted to 2002 US$. Survey results at the end of the intervention were used to estimate the numbers of never smokers, former smokers, light smokers, and heavy smokers in the intervention and comparison counties, and 1986 life tables for populations of US women categorised by smoking status to estimate the gain in life expectancy.

Main outcome measures: Cost effectiveness ratios, as dollars per life-year saved, for the intervention only and for total grant costs (intervention, evaluation and indirect costs).

Results: The cost effectiveness ratio for the intervention, in 2002 US$ per life-year saved, discounted at 3%, was $1156 (90% confidence interval (CI) $567 to ∞), and for the total grant, $4022 (90% CI $1973 to ∞). When discounted at 5%, these ratios were $1922 (90% CI $1024 to $15 647), and $6683 (90% CI $3555 to $54 422), respectively.

Conclusion: The cost effectiveness ratios of this research project are economically attractive, and are comparable with other smoking cessation interventions for women. These observations should encourage further research and dissemination of community based interventions to reduce smoking.

     

Cost effectiveness of vaccinating food service workers against hepatitis A infection

Foodborne transmission is an important means of hepatitis A infection that may be reduced through vaccination of food service workers (FSWs). Several states are considering actions to encourage or mandate FSW vaccination, but the cost effectiveness of such policies has not been assessed. We estimated the clinical and economic consequences of vaccinating FSWs from the 10 states with the highest reported rates of hepatitis A. A decision analytic model was used to predict the effects of vaccinating FSWs at age 20 years. It was assumed all FSWs would receive one dose of inactivated hepatitis A vaccine, and 50% would receive the second recommended dose. Parameter estimates were obtained from published reports and Centers for Disease Control and Prevention databases. The primary endpoint was cost per year of life saved (YOLS). Secondary endpoints were symptomatic infections, days of illness, deaths, and costs of hepatitis A treatment, public health intervention, and work loss. Each endpoint was considered separately for FSWs and patrons. We estimate vaccination of 100,000 FSWs would cost $8.1 million but reduce the costs of hepatitis A treatment, public health intervention, and work loss by $3.0 million, $2.3 million, and $3.1 million, respectively. Vaccination would prevent approximately 2,500 symptomatic infections, 93,000 days of illness, and 8 deaths. A vaccination policy would reduce societal costs while costing the health system $13,969 per YOLS, a ratio that exceeds generally accepted standards of cost effectiveness.     

The association of smoking and the cost of military training

OBJECTIVE: To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING: A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES: Excess training costs as a result of premature discharge. RESULTS: In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS: Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with $18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over $130 million per year in excess training costs.     

Costs of smoking during pregnancy: development of the maternal and child health smoking attributable mortality, morbidity and economic costs (MCHSAMMEC) software

The development and availability is described of new, user friendly software, the Maternal and Child Health Smoking Attributable Mortality, Morbidity and Economic Costs (MCHSAMMEC), that will allow states and other entities to estimate pregnancy related, smoking attributable costs for their population. The methodology underlying the MCHSAMMEC software, including calculations used in the prevalence based analysis of smoking attributable mortality and costs of infant neonatal care, are described, along with design and data management features and possible applications of the software for policy and program development at various levels of the health care system.     

American cigarette manufacturers' ability to pay damages: overview and a rough calculation

The American cigarette industry's ability to pay large damage awards and settlement costs is not limited to its current annual profits of $7.6 billion, or $0.31 per pack. Much larger liability payments could be financed through increased wholesale cigarette prices or higher excise taxes. An increase in the federal cigarette excise tax of 50 cents per pack could yield an estimated $10.8 billion annually in net revenues available for liability costs, while the industry would still retain $5.4 billion, or $0.25 per pack, in pre-tax profits. An increase in cigarette price from its current $1.88 per pack to the full, monopoly profit-maximising level of $4.08 per pack would make more than $32 billion available annually for liability payments or pre-taxed profits.


     

Declining mortality from smoking in the United States.

The proportion of Americans who smoke cigarettes has declined 50% since 1965. The effect on mortality of this considerable reduction has received little attention and is described in this study. U.S. national data were used to enumerate current, former, and never-smokers aged 35 years or older in 1987 and 2002. Mortality rate ratios were used to estimate smoking-attributable deaths among these groups, and corresponding age-adjusted smoking-attributable mortality rates (SAMRs) were calculated. There were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002. The SAMR for men aged 35 years or more was 556 deaths per 100,000 person-years in 1987, accounting for 24% of all male deaths. By 2002 the SAMR declined 41% to 329 and accounted for only 17% of deaths. The SAMR for women in 1987 was 175, accounting for 12% of deaths. By 2002 the SAMR among women had declined 30% to 122, representing 9% of deaths. The U.S. mortality rate attributable to smoking declined about 35% between 1987 and 2002. The impact of smoking on American society will diminish even further in the foreseeable future as smoking prevalence continues its decline among men and women.     

Regional public health cost estimates of contaminated coastal waters: a case study of gastroenteritis at southern California beaches

We present estimates of annual public health impacts, both illnesses and cost of illness, attributable to excess gastrointestinal illnesses caused by swimming in contaminated coastal waters at beaches in southern California. Beach-specific enterococci densities are used as inputs to two epidemiological dose-response models to predict the risk of gastrointestinal illness at 28 beaches spanning 160 km of coastline in Los Angeles and Orange Counties. We use attendance data along with the health cost of gastrointestinal illness to estimate the number of illnesses among swimmers and their likely economic impact. We estimate that between 627,800 and 1,479,200 excess gastrointestinal illnesses occur at beaches in Los Angeles and Orange Counties each year. Using a conservative health cost of gastroenteritis, this corresponds to an annual economic loss of dollars 21 or dollars 51 million depending upon the underlying epidemiological model used (in year 2000 dollars). Results demonstrate that improving coastal water quality could result in a reduction of gastrointestinal illnesses locally and a concurrent savings in expenditures on related health care costs.     

Cost of illness and disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A second-order stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at ?.1 million and ?.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both ?26 for diarrheal illness, both ?5,713 for HUS, and ?.76 million and ?.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were ?,132 and ?,131, respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high.     

Comparison of physician based reporting of tobacco attributable deaths and computer derived estimates of smoking attributable deaths, Oregon, 1989 to 1996

BACKGROUND: Tobacco use prevention programmes need accurate information about smoking related mortality. Beginning in 1989, Oregon began asking physicians to report on death certificates whether tobacco use contributed to the death. OBJECTIVE: To determine the long term comparability of this method of estimating tobacco attributable mortality to estimates of smoking attributable mortality derived from a computer model. DESIGN: For the period 1989 to 1996, we compared mortality resulting from tobacco use reported by Oregon physicians to estimates of smoking attributable deaths (SADs) derived by "Smoking attributable mortality, morbidity and economic costs" software version 3.0 (SAMMEC 3.0), a widely used software program that estimates SADs on the basis of smoking prevalence and relative risks of specific diseases among current and former smokers. MAIN OUTCOME MEASURES: Numbers of deaths, age, sex, and category of disease. RESULTS: Of 212, 448 Oregon deaths during 1989-1996, SAMMEC 3.0 estimated that 42, 778 (20.1%) were attributable to cigarette smoking. For the same 27 diagnoses, physicians reported that tobacco contributed to 42, 839 (20.2%) deaths-a cumulative difference of only 61 deaths over the eight year period. The age and sex distributions of tobacco and smoking attributable deaths reported by the two systems were also similar. By category of disease, the ratio of SAMMEC 3.0 estimates to physician reported deaths was 1.11 for neoplasms, 0.88 for heart disease, and 1.04 for respiratory disease. CONCLUSIONS: Physician reporting provides comparable estimates of smoking attributable mortality and can be a valuable source of data for communicating the risks of tobacco use to the public.     

Economic impact of an Escherichia coli O157:H7 outbreak in Japan.

We estimated the economic impact of an outbreak of foodborne diseases occurring from elementary school lunches in 1996 in which 268 persons in Iwate prefecture, Japan were infected with Escherichia coli O157:H7. This study assessed the impact of direct economic losses and indirect economic consequences due to this outbreak. The economic impact of the outbreak was estimated to be about 82,686,000 yen. The laboratory costs, about 21,204,000 yen, showed the highest ratio of the total cost of this outbreak (about 26%). Also, the cost of foodstuffs that were not purchased during the suspension of the lunch service (about 19%), personnel expenses paid to lunch service employees (about 17%), human illness costs (about 15%), and the repair costs of facilities (about 15%) showed up as a high ratio in the total cost, respectively. Because all patients were children, the productivity losses estimated were low as children were considered as dependants with no income. Instead, we estimated the lost income of the mothers of the children. The source of the contamination could not be identified. Therefore, no food industries suffered any setbacks where certain food items could not be used for daily consumption due to the outbreak.