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Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

Identifieur interne : 003A96 ( Pmc/Curation ); précédent : 003A95; suivant : 003A97

Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

Auteurs : Eileen Stillwaggon [États-Unis] ; Larry Sawers ; Jonathan Rout [Inde] ; David Addiss [Géorgie (pays)] ; Leanne Fox [Géorgie (pays)]

Source :

RBID : PMC:5062793

Abstract

Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.


Url:
DOI: 10.4269/ajtmh.16-0286
PubMed: 27573626
PubMed Central: 5062793

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Larry Sawers
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<p>Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Am J Trop Med Hyg</journal-id>
<journal-id journal-id-type="iso-abbrev">Am. J. Trop. Med. Hyg</journal-id>
<journal-id journal-id-type="publisher-id">tpmd</journal-id>
<journal-title-group>
<journal-title>The American Journal of Tropical Medicine and Hygiene</journal-title>
</journal-title-group>
<issn pub-type="ppub">0002-9637</issn>
<issn pub-type="epub">1476-1645</issn>
<publisher>
<publisher-name>The American Society of Tropical Medicine and Hygiene</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">27573626</article-id>
<article-id pub-id-type="pmc">5062793</article-id>
<article-id pub-id-type="doi">10.4269/ajtmh.16-0286</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India</article-title>
<alt-title alt-title-type="left-running-head">STILLWAGGON AND OTHERS</alt-title>
<alt-title alt-title-type="right-running-head">COSTS AND BENEFITS OF LYMPHEDEMA MANAGEMENT</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Stillwaggon</surname>
<given-names>Eileen</given-names>
</name>
<xref ref-type="aff" rid="AFF1">1</xref>
<xref rid="COR1" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sawers</surname>
<given-names>Larry</given-names>
</name>
<xref ref-type="aff" rid="AFF2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rout</surname>
<given-names>Jonathan</given-names>
</name>
<xref ref-type="aff" rid="AFF3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Addiss</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="AFF4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fox</surname>
<given-names>LeAnne</given-names>
</name>
<xref ref-type="aff" rid="AFF5">5</xref>
</contrib>
</contrib-group>
<aff id="AFF1">
<label>1</label>
Department of Economics, Gettysburg College, Gettysburg, Pennsylvania</aff>
<aff id="AFF2">
<label>2</label>
Department of Economics, American University, Washington, District of Columbia</aff>
<aff id="AFF3">
<label>3</label>
Church's Auxiliary for Social Action (CASA), Bhubaneswar, India</aff>
<aff id="AFF4">
<label>4</label>
Children Without Worms, Task Force for Global Health, Decatur, Georgia</aff>
<aff id="AFF5">
<label>5</label>
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia</aff>
<author-notes>
<corresp id="COR1">*Address correspondence to Eileen Stillwaggon, Department of Economics, Gettysburg College, 300 North Washington Street, Gettysburg, PA 17325. E-mail:
<email>stillwaggon@gettysburg.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>05</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>05</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
<volume>95</volume>
<issue>4</issue>
<fpage>877</fpage>
<lpage>884</lpage>
<history>
<date date-type="received">
<day>12</day>
<month>4</month>
<year>2016</year>
</date>
<date date-type="accepted">
<day>07</day>
<month>7</month>
<year>2016</year>
</date>
</history>
<permissions>
<copyright-statement>©The American Society of Tropical Medicine and Hygiene</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access">
<license-p>This is an open-access article distributed under the terms of the
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<abstract>
<p>Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.</p>
</abstract>
</article-meta>
<notes notes-type="disclaimer">
<p>Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of CDC.</p>
</notes>
</front>
<floats-group>
<table-wrap id="tab1" position="float">
<label>Table 1</label>
<caption>
<p>Parameter values for medical costs and earnings loss due to lymphedema and ADLA
<xref rid="tfn2" ref-type="table-fn">*</xref>
</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" rowspan="1" colspan="1">Parameter</th>
<th align="center" rowspan="1" colspan="1">Baseline estimate 2008–2009</th>
<th align="center" rowspan="1" colspan="1">Source</th>
</tr>
</thead>
<tbody>
<tr>
<td rowspan="1" colspan="1">Annual per-person out-of-pocket medical costs for chronic lymphedema</td>
<td rowspan="1" colspan="1">US$10.96</td>
<td rowspan="1" colspan="1">
<xref rid="R38" ref-type="bibr">38</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Per-episode out-of-pocket medical costs for ADLA</td>
<td rowspan="1" colspan="1">US$2.04</td>
<td rowspan="1" colspan="1">
<xref rid="R37" ref-type="bibr">37</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Annual increase in real cost of medical care for chronic lymphedema and ADLA</td>
<td rowspan="1" colspan="1">4%</td>
<td rowspan="1" colspan="1">
<xref rid="R61" ref-type="bibr">61</xref>
<xref rid="R66" ref-type="bibr">66</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Annual discount rate</td>
<td rowspan="1" colspan="1">3%</td>
<td rowspan="1" colspan="1">
<xref rid="R60" ref-type="bibr">60</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Average daily wage rate</td>
<td rowspan="1" colspan="1">US$1.31</td>
<td rowspan="1" colspan="1">
<xref rid="R39" ref-type="bibr">39</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Annual increase in real wages</td>
<td rowspan="1" colspan="1">4%</td>
<td rowspan="1" colspan="1">
<xref rid="R61" ref-type="bibr">61</xref>
<xref rid="R66" ref-type="bibr">66</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Lost work days per episode due to ADLA</td>
<td rowspan="1" colspan="1">4</td>
<td rowspan="1" colspan="1">
<xref rid="R37" ref-type="bibr">37</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Average number of days worked per year</td>
<td rowspan="1" colspan="1">289</td>
<td rowspan="1" colspan="1">
<xref rid="R67" ref-type="bibr">67</xref>
</td>
</tr>
<tr>
<td colspan="3" rowspan="1">Percentage of work days lost annually due to chronic lymphedema</td>
</tr>
<tr>
<td rowspan="1" colspan="1"> Stages 1–2</td>
<td rowspan="1" colspan="1">0</td>
<td rowspan="4" colspan="1">
<xref rid="R38" ref-type="bibr">38</xref>
,
<xref rid="R42" ref-type="bibr">42</xref>
,
<xref rid="R44" ref-type="bibr">44</xref>
,
<xref rid="R49" ref-type="bibr">49</xref>
,
<xref rid="R51" ref-type="bibr">51</xref>
,
<xref rid="R52" ref-type="bibr">52</xref>
</td>
</tr>
<tr>
<td rowspan="1" colspan="1"> Stage 3</td>
<td rowspan="1" colspan="1">20</td>
</tr>
<tr>
<td rowspan="1" colspan="1"> Stage 4</td>
<td rowspan="1" colspan="1">50</td>
</tr>
<tr>
<td rowspan="1" colspan="1"> Stages 5–7</td>
<td rowspan="1" colspan="1">100</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1">
<p>ADLA = acute dermatolymphangioadenitis.</p>
</fn>
<fn id="tfn2">
<label>*</label>
<p>Derivation of values is explained in
<ext-link ext-link-type="uri" xlink:href="http://www.ajtmh.org/lookup/suppl/doi:10.4269/ajtmh.16-0286/-/DC6/SD6.pdf">Supplemental Information</ext-link>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab2" position="float">
<label>Table 2</label>
<caption>
<p>Stage of lymphedema by age cohort in Khurda census, 2005</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" rowspan="3" colspan="1">Age cohort (years)</th>
<th align="center" rowspan="3" colspan="1">Number of respondents</th>
<th align="center" colspan="8" rowspan="1">Percentage of age cohort at each stage of lymphedema</th>
<th align="center" rowspan="3" colspan="1">Average stage</th>
</tr>
<tr>
<th align="center" colspan="7" rowspan="1">Stage of lymphedema</th>
<th rowspan="1" colspan="1"></th>
</tr>
<tr>
<th align="center" rowspan="1" colspan="1">1</th>
<th align="center" rowspan="1" colspan="1">2</th>
<th align="center" rowspan="1" colspan="1">3</th>
<th align="center" rowspan="1" colspan="1">4</th>
<th align="center" rowspan="1" colspan="1">5</th>
<th align="center" rowspan="1" colspan="1">6</th>
<th align="center" rowspan="1" colspan="1">7</th>
<th align="center" rowspan="1" colspan="1">Total</th>
</tr>
</thead>
<tbody>
<tr>
<td rowspan="1" colspan="1">8–12</td>
<td rowspan="1" colspan="1">74</td>
<td rowspan="1" colspan="1">86.5</td>
<td rowspan="1" colspan="1">6.8</td>
<td rowspan="1" colspan="1">6.8</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.203</td>
</tr>
<tr>
<td rowspan="1" colspan="1">13–17</td>
<td rowspan="1" colspan="1">137</td>
<td rowspan="1" colspan="1">78.8</td>
<td rowspan="1" colspan="1">15.3</td>
<td rowspan="1" colspan="1">2.9</td>
<td rowspan="1" colspan="1">2.2</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.7</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.314</td>
</tr>
<tr>
<td rowspan="1" colspan="1">18–22</td>
<td rowspan="1" colspan="1">267</td>
<td rowspan="1" colspan="1">70.4</td>
<td rowspan="1" colspan="1">18.0</td>
<td rowspan="1" colspan="1">8.6</td>
<td rowspan="1" colspan="1">2.6</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">0.4</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.453</td>
</tr>
<tr>
<td rowspan="1" colspan="1">23–27</td>
<td rowspan="1" colspan="1">443</td>
<td rowspan="1" colspan="1">61.9</td>
<td rowspan="1" colspan="1">24.6</td>
<td rowspan="1" colspan="1">9.5</td>
<td rowspan="1" colspan="1">2.9</td>
<td rowspan="1" colspan="1">0.2</td>
<td rowspan="1" colspan="1">0.9</td>
<td rowspan="1" colspan="1">0.0</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.578</td>
</tr>
<tr>
<td rowspan="1" colspan="1">28–32</td>
<td rowspan="1" colspan="1">866</td>
<td rowspan="1" colspan="1">56.8</td>
<td rowspan="1" colspan="1">24.0</td>
<td rowspan="1" colspan="1">15.1</td>
<td rowspan="1" colspan="1">2.2</td>
<td rowspan="1" colspan="1">0.7</td>
<td rowspan="1" colspan="1">0.9</td>
<td rowspan="1" colspan="1">0.2</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.696</td>
</tr>
<tr>
<td rowspan="1" colspan="1">33–37</td>
<td rowspan="1" colspan="1">1,158</td>
<td rowspan="1" colspan="1">47.8</td>
<td rowspan="1" colspan="1">30.3</td>
<td rowspan="1" colspan="1">16.4</td>
<td rowspan="1" colspan="1">3.7</td>
<td rowspan="1" colspan="1">0.7</td>
<td rowspan="1" colspan="1">0.5</td>
<td rowspan="1" colspan="1">0.6</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.832</td>
</tr>
<tr>
<td rowspan="1" colspan="1">38–42</td>
<td rowspan="1" colspan="1">1,845</td>
<td rowspan="1" colspan="1">43.0</td>
<td rowspan="1" colspan="1">29.7</td>
<td rowspan="1" colspan="1">19.1</td>
<td rowspan="1" colspan="1">5.0</td>
<td rowspan="1" colspan="1">1.2</td>
<td rowspan="1" colspan="1">1.0</td>
<td rowspan="1" colspan="1">1.0</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">1.987</td>
</tr>
<tr>
<td rowspan="1" colspan="1">43–47</td>
<td rowspan="1" colspan="1">1,789</td>
<td rowspan="1" colspan="1">40.9</td>
<td rowspan="1" colspan="1">29.2</td>
<td rowspan="1" colspan="1">21.0</td>
<td rowspan="1" colspan="1">5.5</td>
<td rowspan="1" colspan="1">1.7</td>
<td rowspan="1" colspan="1">1.2</td>
<td rowspan="1" colspan="1">0.6</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.037</td>
</tr>
<tr>
<td rowspan="1" colspan="1">48–52</td>
<td rowspan="1" colspan="1">2,257</td>
<td rowspan="1" colspan="1">38.0</td>
<td rowspan="1" colspan="1">29.2</td>
<td rowspan="1" colspan="1">23.4</td>
<td rowspan="1" colspan="1">6.0</td>
<td rowspan="1" colspan="1">1.7</td>
<td rowspan="1" colspan="1">1.0</td>
<td rowspan="1" colspan="1">0.8</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.104</td>
</tr>
<tr>
<td rowspan="1" colspan="1">53–57</td>
<td rowspan="1" colspan="1">1,723</td>
<td rowspan="1" colspan="1">34.5</td>
<td rowspan="1" colspan="1">28.1</td>
<td rowspan="1" colspan="1">25.2</td>
<td rowspan="1" colspan="1">8.9</td>
<td rowspan="1" colspan="1">1.7</td>
<td rowspan="1" colspan="1">0.8</td>
<td rowspan="1" colspan="1">0.8</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.208</td>
</tr>
<tr>
<td rowspan="1" colspan="1">58–62</td>
<td rowspan="1" colspan="1">2,441</td>
<td rowspan="1" colspan="1">31.0</td>
<td rowspan="1" colspan="1">30.1</td>
<td rowspan="1" colspan="1">25.8</td>
<td rowspan="1" colspan="1">8.6</td>
<td rowspan="1" colspan="1">2.5</td>
<td rowspan="1" colspan="1">1.4</td>
<td rowspan="1" colspan="1">0.6</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.280</td>
</tr>
<tr>
<td rowspan="1" colspan="1">63–67</td>
<td rowspan="1" colspan="1">1,400</td>
<td rowspan="1" colspan="1">29.3</td>
<td rowspan="1" colspan="1">31.2</td>
<td rowspan="1" colspan="1">25.8</td>
<td rowspan="1" colspan="1">9.1</td>
<td rowspan="1" colspan="1">2.0</td>
<td rowspan="1" colspan="1">1.9</td>
<td rowspan="1" colspan="1">0.7</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.318</td>
</tr>
<tr>
<td rowspan="1" colspan="1">68–72</td>
<td rowspan="1" colspan="1">1,453</td>
<td rowspan="1" colspan="1">29.9</td>
<td rowspan="1" colspan="1">28.4</td>
<td rowspan="1" colspan="1">26.8</td>
<td rowspan="1" colspan="1">10.1</td>
<td rowspan="1" colspan="1">2.3</td>
<td rowspan="1" colspan="1">1.7</td>
<td rowspan="1" colspan="1">0.8</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.352</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Total</td>
<td rowspan="1" colspan="1">15,853</td>
<td rowspan="1" colspan="1">39.5</td>
<td rowspan="1" colspan="1">28.6</td>
<td rowspan="1" colspan="1">21.9</td>
<td rowspan="1" colspan="1">6.6</td>
<td rowspan="1" colspan="1">1.6</td>
<td rowspan="1" colspan="1">1.1</td>
<td rowspan="1" colspan="1">0.7</td>
<td rowspan="1" colspan="1">100.0</td>
<td rowspan="1" colspan="1">2.084</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab3" position="float">
<label>Table 3</label>
<caption>
<p>ADLA episodes in previous year experienced by persons in each lymphedema stage in Khurda census, 2005</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" rowspan="2" colspan="1">Stage of lymphedema</th>
<th align="center" colspan="5" rowspan="1">Percentage of persons in each stage with ADLA episodes</th>
</tr>
<tr>
<th align="center" rowspan="1" colspan="1">0 episode</th>
<th align="center" rowspan="1" colspan="1">1 episode</th>
<th align="center" rowspan="1" colspan="1">2 episodes</th>
<th align="center" rowspan="1" colspan="1">3 episodes</th>
<th align="center" rowspan="1" colspan="1">Total</th>
</tr>
</thead>
<tbody>
<tr>
<td rowspan="1" colspan="1">1</td>
<td rowspan="1" colspan="1">17.1</td>
<td rowspan="1" colspan="1">68.7</td>
<td rowspan="1" colspan="1">7.8</td>
<td rowspan="1" colspan="1">6.4</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">2</td>
<td rowspan="1" colspan="1">16.1</td>
<td rowspan="1" colspan="1">71.4</td>
<td rowspan="1" colspan="1">7.2</td>
<td rowspan="1" colspan="1">5.2</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">3</td>
<td rowspan="1" colspan="1">15.2</td>
<td rowspan="1" colspan="1">69.4</td>
<td rowspan="1" colspan="1">9.2</td>
<td rowspan="1" colspan="1">6.3</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">4</td>
<td rowspan="1" colspan="1">14.2</td>
<td rowspan="1" colspan="1">68.5</td>
<td rowspan="1" colspan="1">9.6</td>
<td rowspan="1" colspan="1">7.7</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">5</td>
<td rowspan="1" colspan="1">15.7</td>
<td rowspan="1" colspan="1">58.7</td>
<td rowspan="1" colspan="1">12.3</td>
<td rowspan="1" colspan="1">13.3</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">6</td>
<td rowspan="1" colspan="1">10.8</td>
<td rowspan="1" colspan="1">62.1</td>
<td rowspan="1" colspan="1">12.8</td>
<td rowspan="1" colspan="1">14.3</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">7</td>
<td rowspan="1" colspan="1">12.6</td>
<td rowspan="1" colspan="1">57.1</td>
<td rowspan="1" colspan="1">15.1</td>
<td rowspan="1" colspan="1">15.1</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
<tr>
<td rowspan="1" colspan="1">Average</td>
<td rowspan="1" colspan="1">16.1</td>
<td rowspan="1" colspan="1">69.3</td>
<td rowspan="1" colspan="1">8.2</td>
<td rowspan="1" colspan="1">6.4</td>
<td rowspan="1" colspan="1">100.0</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn3">
<p>ADLA = acute dermatolymphangioadenitis.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab4" position="float">
<label>Table 4</label>
<caption>
<p>Work days lost annually, annual earnings lost, and annual out-of-pocket medical costs due to lymphedema and ADLA for each age cohort at program start, 2008–2009
<xref rid="tfn5" ref-type="table-fn">*</xref>
</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" rowspan="2" colspan="1">5-year cohort</th>
<th align="center" colspan="2" rowspan="1">Work days lost annually</th>
<th align="center" rowspan="2" colspan="1">Annual earnings lost due to lymphedema and ADLA</th>
<th align="center" colspan="2" rowspan="1">Annual out-of-pocket medical costs</th>
</tr>
<tr>
<th align="center" rowspan="1" colspan="1">Due to lymphedema</th>
<th align="center" rowspan="1" colspan="1">Due to ADLA</th>
<th align="center" rowspan="1" colspan="1">Due to lymphedema</th>
<th align="center" rowspan="1" colspan="1">Due to ADLA</th>
</tr>
</thead>
<tbody>
<tr>
<td rowspan="1" colspan="1">18–22</td>
<td rowspan="1" colspan="1">2,630</td>
<td rowspan="1" colspan="1">1,084</td>
<td rowspan="1" colspan="1">US$4,865</td>
<td rowspan="1" colspan="1">US$2,926</td>
<td rowspan="1" colspan="1">US$553</td>
</tr>
<tr>
<td rowspan="1" colspan="1">23–27</td>
<td rowspan="1" colspan="1">5,751</td>
<td rowspan="1" colspan="1">1,796</td>
<td rowspan="1" colspan="1">US$9,887</td>
<td rowspan="1" colspan="1">US$4,855</td>
<td rowspan="1" colspan="1">US$916</td>
</tr>
<tr>
<td rowspan="1" colspan="1">28–32</td>
<td rowspan="1" colspan="1">14,941</td>
<td rowspan="1" colspan="1">3,568</td>
<td rowspan="1" colspan="1">US$24,247</td>
<td rowspan="1" colspan="1">US$9,491</td>
<td rowspan="1" colspan="1">US$1,820</td>
</tr>
<tr>
<td rowspan="1" colspan="1">33–37</td>
<td rowspan="1" colspan="1">23,265</td>
<td rowspan="1" colspan="1">4,784</td>
<td rowspan="1" colspan="1">US$36,744</td>
<td rowspan="1" colspan="1">US$12,692</td>
<td rowspan="1" colspan="1">US$2,440</td>
</tr>
<tr>
<td rowspan="1" colspan="1">38–42</td>
<td rowspan="1" colspan="1">50,835</td>
<td rowspan="1" colspan="1">7,568</td>
<td rowspan="1" colspan="1">US$76,508</td>
<td rowspan="1" colspan="1">US$20,221</td>
<td rowspan="1" colspan="1">US$3,860</td>
</tr>
<tr>
<td rowspan="1" colspan="1">43–47</td>
<td rowspan="1" colspan="1">53,754</td>
<td rowspan="1" colspan="1">7,460</td>
<td rowspan="1" colspan="1">US$80,190</td>
<td rowspan="1" colspan="1">US$19,607</td>
<td rowspan="1" colspan="1">US$3,805</td>
</tr>
<tr>
<td rowspan="1" colspan="1">48–52</td>
<td rowspan="1" colspan="1">72,626</td>
<td rowspan="1" colspan="1">9,204</td>
<td rowspan="1" colspan="1">US$107,197</td>
<td rowspan="1" colspan="1">US$24,737</td>
<td rowspan="1" colspan="1">US$4,694</td>
</tr>
<tr>
<td rowspan="1" colspan="1">53–57</td>
<td rowspan="1" colspan="1">63,725</td>
<td rowspan="1" colspan="1">7,096</td>
<td rowspan="1" colspan="1">US$92,775</td>
<td rowspan="1" colspan="1">US$18,884</td>
<td rowspan="1" colspan="1">US$3,619</td>
</tr>
<tr>
<td rowspan="1" colspan="1">58–62</td>
<td rowspan="1" colspan="1">98,405</td>
<td rowspan="1" colspan="1">10,224</td>
<td rowspan="1" colspan="1">US$142,303</td>
<td rowspan="1" colspan="1">US$26,753</td>
<td rowspan="1" colspan="1">US$5,214</td>
</tr>
<tr>
<td rowspan="1" colspan="1">63–67</td>
<td rowspan="1" colspan="1">57,858</td>
<td rowspan="1" colspan="1">6,196</td>
<td rowspan="1" colspan="1">US$83,910</td>
<td rowspan="1" colspan="1">US$15,344</td>
<td rowspan="1" colspan="1">US$3,160</td>
</tr>
<tr>
<td rowspan="1" colspan="1">68–72</td>
<td rowspan="1" colspan="1">64,245</td>
<td rowspan="1" colspan="1">6,192</td>
<td rowspan="1" colspan="1">US$92,272</td>
<td rowspan="1" colspan="1">US$15,925</td>
<td rowspan="1" colspan="1">US$3,158</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn4">
<p>ADLA = acute dermatolymphangioadenitis.</p>
</fn>
<fn id="tfn5">
<label>*</label>
<p>See
<ext-link ext-link-type="uri" xlink:href="http://www.ajtmh.org/lookup/suppl/doi:10.4269/ajtmh.16-0286/-/DC6/SD6.pdf">Supplemental Information</ext-link>
for derivation of values.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
</record>

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