title: Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.
abstract: BACKGROUND
  Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity.
  
  
  OBJECTIVE
  This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature.
  
  
  METHODS
  A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries.
  
  
  CONCLUSIONS
  Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden.
authors.affiliation: Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia. Electronic address: luke.robinson@monash.edu.
authors.forename: Luke Steven
authors.initials: LS
authors.lastname: Robinson
authors.affiliation: Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sarkies
authors.affiliation: Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia.
authors.forename: Ted
authors.initials: T
authors.lastname: Brown
authors.affiliation: Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: O'Brien
mesh_terms: D000041:Absenteeism; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D017281:Cost of Illness; D004651:Employment / Q000706:statistics & numerical data*; D006230:Hand Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D014481:United States / Q000453:epidemiology; D014954:Wrist Injuries / Q000191:economics* / Q000453:epidemiology / Q000628:therapy
keywords: Cost of illness; Efficiency; Hand injury; Health care costs; Health expenditures; Wrist injury