ABSTRACT
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 USD 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 USD 532 million for active smoking and USD 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 USD 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.
Subject(s)
Health Care Costs , Smoking/economics , Tobacco Smoke Pollution/economics , Tobacco Use Disorder/economics , Absenteeism , Adult , Aged , Cost of Illness , Female , Hong Kong/epidemiology , Hospitalization/economics , Humans , Long-Term Care/economics , Male , Middle Aged , Patient Acceptance of Health Care , Primary Health Care/economics , Smoking/adverse effects , Smoking/mortality , Tobacco Smoke Pollution/adverse effects , Tobacco Use Disorder/mortality , Value of Life/economicsABSTRACT
An evaluation of voluntary prenatal screening for neural tube defects with serum alphafetoprotein (s-AFP) is presented. During a three year period, there were 52 fetuses with neural lesions. Of 46 mothers who bore a fetus with an open neural lesion, 25 were detected, of whom 23 agreed to the termination of their pregnancies. An unscreened group of 2331 mothers (17% of all deliveries) produced 14 fetuses with neural tube defects, an incidence of 6.0 per 1000, 1.8 times the incidence (3.3 per 1000) in the screened group. Pitfalls occurring in the assessment of hyper-alphafetoproteinemia included inaccurate gestational dating and allowance for excessive body weight. The results of a robust AFP-NTD screening programme supported in selected cases by ultrasonar visualisation of the spine argue for its continuance in this district.
Subject(s)
Neural Tube Defects/diagnosis , Prenatal Diagnosis , Child, Preschool , False Negative Reactions , Female , Gestational Age , Humans , Neural Tube Defects/blood , Pregnancy , Spina Bifida Occulta/diagnosis , Urban Population , alpha-Fetoproteins/analysisABSTRACT
Characteristics of the T4 and T3 radioimmunoassay kits that are commercially available in the UK are described. Useful comparative data and criticism are given about many of these kits. Some unacceptable variation in accuracy is demonstrated.
