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The Economic Burden of Spinal Cord Injury: A Literature Review and Analysis

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Making the Case for Primary Prevention: An Economic Analysis of Risk Factors in Manitoba

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The Economic Burden of Skin Cancer in Canada: Current and Projected

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Implementing a Human Papillomavirus Vaccination Program: Evidence on Cost-effectiveness

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An Overview of Selected Cancers and Modifiable Cancer Risk Factors in Canada

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The Value of Emergency Medicine in British Columbia

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Cancer Prevention Newsletters

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A Population Based HPV Immunization Program in British Columbia: Background Paper

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Priority Criteria for Hip and Knee Replacement: Addressing Health Service Wait Times

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A Business Plan for Improving Rheumatoid Arthritis Managment in British Columbia

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Risk Factors for Chronic Disease ("The Winning Legacy")

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Planning for Renewal: Mapping Primary Health Care in BC

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Hip & Knee Replacement Surgery

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A Positron Emission Tomography Program in British Columbia: Business Plan

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Spinal cord injuries exact a substantial burden on both the individual and society. In December 2010, H. Krueger & Associates Inc. completed a report for the Rick Hansen Institute on the cost of spinal cord injury. A review of the relevant work in this area is presented, along with an analysis of the data to give an estimate of the total economic burden of spinal cord injury in Canada.









What is the cost of unhealthy living in Manitoba? H. Krueger & Associates Inc. recently completed a report for the Heart and Stroke Foundation of Manitoba and other partners in prevention, finding that obesity, physical inactivity, and smoking will cost Manitoba taxpayers $4.7 billion in increased health care expenditures and lost productivity by 2026. The findings suggest that just a 1 per cent annual reduction in risk factors, starting in 2011 and using a sample investment of $529 million, would result in nearly $1.8 billion saved on direct and indirect costs, a greater than 3-to-1 return on investment. The report is the first of its kind in Manitoba to provide solid economic data on the long-term economic burden associated with these risk factors; this is important evidence for investment in primary prevention activities at the provincial, regional, and local levels.





H. Krueger & Associates Inc. was contracted by the Canadian Partnership Against Cancer to prepare a Pan-Canadian Analysis of the Economic Burden of Skin Cancer. The work, which was completed in February 2010, includes projecting the future incidence of melanoma and non-melanoma skin cancers, estimating both the current and projected economic burden associated with these skin cancers and determining the potential impact of a comprehensive skin cancer prevention program in Canada.









There has been a substantial increase in the published research on the cost-effectiveness of the HPV vaccine. In the report, Implementing a Human Papillomavirus Vaccination Program: Evidence on Cost-effectiveness, we critically review this literature published to the end of November 2008. Included are a summary of the results to date, suggestions for improving the quality of the current literature and areas for further research.







Does cancer prevention really make a difference? In the report, An Overview of Selected Cancers and Modifiable Cancer Risk Factors in Canada, we examined regional differences in factors that modify cancer risk including smoking, vegetable and fruit consumption, physical (in)activity, obesity, alcohol consumption and breastfeeding. These differences were then compared to regional differences in the cancers most closely associated with these specific risk factors. The report concludes that “there is significant variability between the provinces with respect to the factors that modify cancer risk and the associated cancers. This suggests substantial possibilities for improving these factors and thereby reducing the incidence of preventable cancers.”





Emergency physicians (EPs) provide an undeniably important service; one that is not easily replaceable by other resources in the health care system. Yet the pay increases negotiated for physicians since 1993 have left those working in emergency medicine (EM) behind. At the same time the demands of EM have become much more serious and complex, due to an aging population and rise in serious infectious diseases.

This paper seeks to address the issue of fair compensation for British Columbia EPs by looking at a number of factors, including the background of EM in Canada and history of service contract negotiations in BC, the work offered by EPs, and the societal benefits of treating emergency physicians fairly.





We have been commissioned by the BC Cancer Agency to write a series of cancer prevention newsletters. The newsletters provide clinicians with an understanding of the preventable risk factors associated with cancer—such as physical inactivity, obesity and tobacco use, among others. The benefit of addressing these risk factors is made clear, together with suggested responses to assist clinicians in this process.

Cancer Prevention Newsletter: Issue 1

Cancer Prevention Newsletter: Issue 2

Cancer Prevention Newsletter: Issue 3

Cancer Prevention Newsletter: Issue 4

Cancer Prevention Newsletter: Issue 5

Cancer Prevention Newsletter: Issue 6

Cancer Prevention Newsletter: Issue 7

Cancer Prevention Newsletter: Issue 8





The fact that viral infections can cause cancer has been suspected for over a hundred years. It is now known that the vast majority of cervical cancers can be traced to infection with human papillomavirus (HPV). This conclusion is unique in cancer research; no other cancer in humans has been shown to have such a clear and necessary cause.

In addition to cervical cancers, HPV infection has been implicated in a variety of other cancers and non-malignant diseases.

A number of pharmaceutical companies are close to bringing an HPV vaccine to the market.

A Population Based HPV Immunization Program in British Columbia: Background Paper, prepared for the BC Cancer Agency Cancer Prevention Program, provides information to begin addressing the following questions:

• How many cancers and other diseases might be prevented by such a program?
• What are the expected side-effects of an HPV vaccine?
• Should an immunization program be implemented in BC?
• If so, should it be targeted to specific groups or be implemented population wide?
• Would an HPV immunization program in BC be cost-effective?

This project, focusing on joint replacement surgery, is part of a pan-Canadian research initiative on waits for health care services. The overall project has been sponsored and managed by the Canadian Institute of Health Research on behalf of the Ministers of Health across the country. The highly experienced team for this contract was led by Dr. Bassam Masri. Research and writing support for the project has been provided by H. Krueger & Associates Inc. The three phases of the work are:

REPORT 1 - to critically appraise the available literature regarding benchmarks and prioritization tools that have been developed around the world (July, 2005).

REPORT 2 - to assess the reality of the wait lists across Canada, and determine what initiatives have been used to improve access to care in the various jurisdictions (October, 2005).

REPORT 3 - to examine the gaps in understanding possible strategies to improve access to care and wait times, and propose priority areas for research and evidence based studies (April, 2006).

The B.C. and Yukon Division of the Arthritis Society has joined together with the B.C. Ministry of Health Services to develop the Arthritis Chronic Disease Management Strategy. The strategy is aimed at bridging the gap between current care and optimal care. We developed a business plan which assessed the current situation for rheumatoid arthritis, focusing on the gaps in care, and developed financial and management models to better meet the future demand for treatment options.

The business plan has a focus on tackling chronic disease aggressively and, if implemented, would potentially result in significant cost-avoidance for the economy, as well as improve the lives of thousands of people living with rheumatoid arthritis.





The BC Healthy Living Alliance needed a solid business case to support their request for $1.1 billion in new funding for preventative services. Our approach resulted in a five-year plan to meet BC’s goal of being the healthiest jurisdiction to ever host an Olympics.

• STEP 1: We undertook a major literature review to examine the links between smoking, unhealthy eating, physical inactivity, and obesity and chronic diseases such as cancer, heart disease, and diabetes. We researched the status of these risk factors in British Columbia, and reviewed target-setting efforts in other jurisdictions.
  
• STEP 2: We participated in consultations with BC’s six health authorities to help set 2010 targets for the four key risk factors. These targets were published in January 2005 in Healthy Living: Targets for 2010.
  
• STEP 3: Targets are one thing. But health care planners need to know how to achieve them. We conducted a second literature search to identify which interventions are likely to be most successful in controlling the key risk factors.
  
• STEP 4: Health care resources are always limited. A key step was to select the most cost-effective interventions for a province-wide program to reduce risk factors. The report identified 27 recommendations and the costs associated with their implementation.
  
• STEP 5: A final plain language report, The Winning Legacy: A Plan for Improving the Health of British Columbians by 2010, provided a summary of the entire project.

The University of British Columbia’s Centre for Health Services and Policy Research is undertaking a multi-stage research program to inform primary health care renewal initiatives in BC.

We coordinated and provided analytical expertise for an initial project designed to offer a snapshot of primary health care in BC. The resulting report, Planning for Renewal: Mapping Primary Health Care in British Columbia, presents over twenty profiles illustrating geographic variation and distribution across the province, and the relationship between health status and services use.





The demand for hip and knee replacement surgeries is increasing rapidly in developed nations. Many jurisdictions, including British Columbia, are struggling with a growing waiting list for these procedures. In April 2004, we produced Hip and Knee Replacement Surgery in British Columbia: Historical Volumes and Projected Need for the BC Orthopaedic Association and the Arthritis Society, BC and Yukon Division. Based on this report, a substantial increase in funding was allocated to expand the number of hip and knee replacement procedures in the province.





In December of 2002, we produced A Positron Emission Tomography Program in British Columbia: Business Plan for the British Columbia Cancer Agency and Vancouver area nuclear medicine specialists. This program, the first of its kind in British Columbia, was funded by the provincial government in December of 2004 and is currently being implemented at the British Columbia Cancer Agency - Vancouver Centre. The BC Cancer Agency, in collaboration with the University of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Children's Hospital and TRIUMF, are developing a Centre of Excellence for Functional Imaging that will include a cyclotron, a radionuclide pharmacy, and the PET/CT scanner. These programs will accelerate the BC Cancer Agency's translational research mandate, and enable the Agency to compete on a world stage for research funds.