BackgroundChronic fatigue syndrome (CFS) is a debilitating chronic illness affecting at least 4 million people in the United States. Understanding its cost improves decisions regarding resource allocation that may be directed towards treatment and cure, and guides the evaluation of clinical and community interventions designed to reduce the burden of disease.MethodsThis research estimated direct and indirect costs of CFS and the impact on educational attainment using a population-based, case-control study between September 2004 and July 2005, Georgia, USA. Participants completed a clinical evaluation to confirm CFS, identify other illnesses, and report on socioeconomic factors. We estimated the effect of CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services) and loss in productivity (employment and earnings) with a stratified sample (n = 500) from metropolitan, urban, and rural Georgia. We adjusted medical costs and earnings for confounders (age, sex, race/ethnicity, education, and geographic strata) using econometric models and weighted estimates to reflect response-rate adjusted sampling rates.ResultsIndividuals with CFS had mean annual direct medical costs of $5,683. After adjusting for confounding factors, CFS accounted for $3,286 of these costs (p < 0.01), which were driven by increased provider visits and prescription medication use. Nearly one-quarter of these expenses were paid directly out-of pocket by those with CFS. Individuals with CFS reported mean annual household income of $23,076. After adjustment, CFS accounted for $8,554 annually in lost household earnings (p < 0.01). Lower educational attainment accounted for 19% of the reduction in earnings associated with CFS.ConclusionsStudy results indicate that chronic fatigue syndrome may lead to substantial increases in healthcare costs and decreases in individual earnings. Studies have estimated up to 2.5% of non-elderly adults may suffer from CFS. In Georgia, a state with roughly 5.5 million people age 18-59, illness could account for $452 million in total healthcare expenditures and $1.2 billion of lost productivity.
This article reports the results of the national evaluation of the Food Stamp Employment and Training (E&T) Program, based on an experimental study involving over 13,000 program participants in 53 separate local food stamp agencies. The story told by these findings begins with the types of individuals who participated in the E&T Program in FY 1988. Nearly 70 percent did not have children (removing this barrier to finding employment), and about half were single, highly mobile adults living alone. Most received no public assistance other than food stamps. For the most part, then, these were individuals who needed to work—food stamp benefits are not intended to meet total subsistence needs. It would, therefore, be expected that most of the E&T participants would be looking for work (whether or not they were successful) in the absence of E&T requirements. Next, it is apparent that large numbers of E&T participants did not engage in employment or training services in FY 1988. As currently structured, beyond imposing the obligation to meet the requirements of E&T, the program failed to provide any actual services to about half of those deemed eligible to participate. For the most part, the services received by E&T participants consisted primarily of referral to individual job search. In the absence of E&T, many of the individuals currently targeted by the program were able to obtain similar referrals on their own. Consequently, it is not surprising, that E&T was found to have no effect on participants' employment and earnings, and only a relatively small effect on average food stamp benefits.
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