title: Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study.
abstract: BACKGROUND
  Injuries to the hand and wrist account for approximately 20% of patient visits to emergency departments and may impose a large economic burden. The purpose of this study was to estimate the total health-care costs and productivity costs of injuries to the hand and wrist and to compare them with other important injury groups in a nationwide study.
  
  
  METHODS
  Data were retrieved from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry, and from a patient follow-up survey conducted between 2007 and 2008. Injury incidence, health-care costs, and productivity costs (due to absenteeism) were calculated by age group, sex, and different subgroups of injuries. An incidence-based cost model was used to estimate the health-care costs of injuries. Follow-up data on return to work rates were incorporated into the absenteeism model for estimating the productivity costs.
  
  
  RESULTS
  Hand and wrist injuries annually account for $740 million (in U.S. dollars) and rank first in the order of most expensive injury types, before knee and lower limb fractures ($562 million), hip fractures ($532 million), and skull-brain injury ($355 million). Productivity costs contributed more to the total costs of hand and wrist injuries (56%) than did direct health-care costs. Within the overall group of hand and wrist injuries, hand and finger fractures are the most expensive group ($278 million), largely due to high productivity costs in the age group of twenty to sixty-four years ($192 million).
  
  
  CONCLUSIONS
  Hand and wrist injuries not only constitute a substantial part of all treated injuries but also represent a considerable economic burden, with both high health-care and productivity costs. Hand and wrist injuries should be a priority area for research in trauma care, and further research could help to reduce the cost of these injuries, both to the health-care system and to society.
authors.affiliation: Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. ddeputter@gmail.com
authors.forename: C E
authors.initials: CE
authors.lastname: de Putter
authors.forename: R W
authors.initials: RW
authors.lastname: Selles
authors.forename: S
authors.initials: S
authors.lastname: Polinder
authors.forename: M J M
authors.initials: MJ
authors.lastname: Panneman
authors.forename: S E R
authors.initials: SE
authors.lastname: Hovius
authors.forename: E F
authors.initials: EF
authors.lastname: van Beeck
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D004526:Efficiency; D005260:Female; D006230:Hand Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D014954:Wrist Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult