Economic Impact of Hand and Wrist Injuries: Health-Care Costs and Productivity Costs in a Population-Based Study C.E. de Putter, MD, R.W. Selles, PhD, S. Polinder, PhD, M.J.M. Panneman, MSc, S.E.R. Hovius, MD, PhD, and E.F. van Beeck, MD, PhD Investigation performed at the Erasmus MC Rotterdam, Rotterdam, and the Consumer and Safety Institute, Amsterdam, The Netherlands 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 pro- ductivity 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. I njuries to the hand and wrist account for approximately 20% of visits to emergency departments 1,2 . Besides the impact of hand and wrist injuries on physical and mental health, they can lead to high health-care costs and prolonged time off from work 3-11 . As a consequence, these injuries may impose a considerable economic burden to the community. Because of rising health-care costs, economic analyses are considered increasingly important 12 . To date, only a few single- center studies have estimated the costs of hand and wrist in- juries, and population-based studies on this topic are scarce 13-25 . From previous studies, we know that productivity costs due to work absenteeism generally are even larger than health-care costs 26 . Population-based information about these economic production losses could therefore be important to policy makers in the area of injury control, but such an analysis has not been done for hand and wrist injuries. The purposes of this nationwide study were to examine health-care costs and productivity costs due to hand and wrist injuries and to compare these costs with those of other main injury groups. Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. e56(1) COPYRIGHT Ó 2012 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED J Bone Joint Surg Am. 2012;94:e56(1-7) d http://dx.doi.org/10.2106/JBJS.K.00561