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38 The societal perspective, in addition to direct medical costs, includes direct nonmedical costs and potential indirect costs.
This produces a direct cost (in the form of greater spending on fuel), as well as potential indirect costs in the form of greater greenhouse gas emissions.
The costs of managing possible sequelae caused by severe RSV infection (recurrent wheezing) were also considered, as were potential indirect costs due to lost productivity following the death of a child (societal perspective).
When herd immunity was considered in all age groups below 25 years, rotavirus vaccination corresponded to an ICER of €3,200 despite the exclusion of utility estimates for individuals aged 5 years and older experiencing rotavirus infection, any possible deaths in these older individuals and potential indirect costs.
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Moreover, in addition to the direct cost savings to the health care system that may be realized, there are potential indirect cost savings associated with our intervention as well, such as the potential to avoid disastrous human loss and suffering caused by viruses such as the Severe Acute Respiratory Syndrome (SARS).
Equally, the enormous potential debilitating indirect costs of retinopathy on patients could be curbed with increased productivity and decreased disability.
Whereas the human capital approach assumes a perfect labour market, the frictional costs approach charges only 80% of losses of the human capital approach to avoid potential overestimation of indirect costs [ 32].
A separate sensitivity analysis will explore the potential importance of including productivity (indirect) costs of patients/carers alongside direct costs in the societal perspective analysis.
Other costs to the hospital ward and staff, patients and other possible subjects were not included as well as the long term impact of potential decreased productivity and other indirect costs.
In a similar way, and without considering potential indirect land use effects, the costs to taxpayers of reducing greenhouse gas emissions through tax credits are about $750 per metric ton of CO2-equivalent for ethanol and around $275 per metric ton for cellulosic ethanol.
We do not include indirect costs such as potential earnings forgone by the carers [60].
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