Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review

Mr Luke Robinson1, Mr Mitchell Sarkies2, Associate Professor Ted Brown1, Associate Professor Lisa O’Brien1

1Occupational Therapy Department – Monash University , Frankston , Australia, 2Physiotherapy Department – Monash University , Frankston, Australia


Background: Injuries sustained to the hand and wrist are common. Economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive.


Aim: Systematically review cost-of-illness studies (COIs) and health economic evaluations (HEEs) investigating acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. Provide economic cost estimates of burden and discuss the cost components used in international literature.


Method: A search of COIs and HEEs in various databases was conducted. Study design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs were extracted. Reported costs were converted into US-dollars and adjusted into 2015 US-dollars.


Results: Twenty-one studies met the inclusion criteria. Twelve studies were COIs, and seven were HEE. Methodologies used to derive costs differed markedly across all studies. Indirect costs represented a significant portion of total cost in both COIs [64.5% (IQR 50.75–88.25)] and HEEs [68% (IQR 49.25–73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357–$22,274) for COIs and US$8297 (IQR $3858–$33,939) for HEEs. Few studies reported intangible cost data associated with acute hand and wrist injuries. Allied health intervention was found to be as low as 1% of total cost.


Significance of the findings to allied health: 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. Conducting COIs in Australia may provide guidance to relevant policy makers on how to expand limited resources by identifying the major disorders and exposures resulting in the largest burden.