The costs of implementing and operating an oral health service from the perspective of the service and society

The aim of this study was to assess the costs of setting up and maintaining dental care in the public sector. Costs were updated or depreciated according to the service's lifespan and were analyzed from the perspective of the service itself and society. According to the findings, for the service the total cost of setting up a dental care unit with seven rooms was BRL$860.643.67 in the first year, plus BRL$545,419.23 for maintenance, and clinical dental care was the most expensive specialty. For society, the total cost was BRL$990,065.06 (implementation) and BRL$668,369.55 (maintenance), and the most expensive specialty was prevention (US$1.00 = BRL$1.62). Capital costs represented a small percentage of total costs for a dental care unit, but they need to be considered, since they can modify the results. Due to the high costs, preventive and promotional interventions should not be performed in the clinical setting, but should be replaced by broader and less expansive population-based interventions, since considerable sums need to be spent by the low-income population to participate in free public programs.     

Hidden health costs of pesticide use in Zimbabwe's smallholder cotton growers

Balancing the numerous benefits that may accrue from pesticide use on cotton, farmers face health hazards. Pesticide-induced acute symptoms significantly increased the cost-of-illness in a survey of 280 smallholder cotton growers in two districts of Zimbabwe. Cotton growers lost a mean of 180 Zimbabwe dollars in Sanyati and 316 Zimbabwe dollars per year in Chipinge on pesticide-related direct and indirect acute health effects. These values are equivalent to 45% and 83% of annual household pesticide expenditures in the two districts. The time spent recuperating from illnesses attributed to pesticides averaged 2 days in Sanyati and 4 days in Chipinge during the 1998/1999 growing season. These pesticide health cost estimates represent lower bounds only; they omit chronic pesticide health effects as well as suffering and other non-monetary costs. Acute pesticide symptoms were determined in large part by pesticide use practices, notably the lack of protective clothing. Yet many smallholder farmers misunderstood pesticide health hazards, and so did little to protect themselves. Despite the use of simple color codes, 22% of smallholder cotton growers in Sanyati and 58% in Chipinge did not know how the four colored triangles communicated increasing degrees of pesticide toxicity. Better farmer education in exposure averting strategies is needed. Likewise, fuller accounting for hidden health costs in future would allow farmers to make more informed decisions about agricultural pest management.     

Economic costs of HIV infection: an employer's perspective

The introduction of highly active antiretroviral therapy has proven highly effective in treating patients with HIV/AIDS. However, the high cost of the advanced antiretroviral therapy has led to increased financial constraints on both patients and payers. From business firms'perspective, especially those with operations in developing countries, it is crucial to determine the long-term economic cost implications of alternative employment and benefit policies for HIV-infected workers or those at high risk for the disease. A simulation model is developed to predict the comprehensive lifetime economic costs of HIV-infected workers to an employer. This model employs age,CD4⁺ cell counts,and plasma HIV-1 RNA level as major predictors of the disease progression and patient survival in the determination of various cost functions.Major cost components considered include direct expenses on health insurance premium,life insurance premium, short-term disability benefits, long-term disability benefits, hiring/training expenses, and indirect costs resulting from reduced or lost productivity at work. An individual model and a group model are derived to estimate the costs of an individual and a group of HIV-infected patients, respectively.Over a 10-year period, following the nonadvanced antiretroviral treatment regimen, the group model predicts that the total lifetime cost of an HIV-infected worker can be as high as U.S. $90,000 to his/her employer, of which $60,000 would be various explicit costs and $30,000 lost work productivity. Sensitivity analysis further demonstrated that changes in the initial level of age,CD4⁺ cell count, HIV-1 RNA viral load,CD4⁺ cell decline rate, and the costs of medical care influence the dynamics of the cost functions. HIV infection can result in sizable economic costs to an employer over the lifetime course of an infected employee if not treated with the advanced antiretroviral therapy.These cost estimates provide a rational economic basis for an employer to optimally assess the longrun costs and benefits of alternative employment and insurance policies in the care of employees with HIV infection. Gordon G. Liu Pharmaceutical Policy and Evaluative Sciences, Beard Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7360, USA, e-mail: ggliu@unc.edu