Burden Summary
Economic Burden by Condition
Per-Condition Economic Burden
Human capital (HC): DALYs × $62,000 · VSL: Deaths × $12,370,062 · Ranked by HC burden
| Condition | DALYs/yr | Deaths/yr | HC Burden (HC = DALYs × $62K) | VSL Burden (deaths × $12.4M) | Total DALY-based burden | Rank (HC) |
|---|---|---|---|---|---|---|
| Cancer C00–C97 | 1,812 | 83 | $112.3M | $1,026.7M | $1,139.0M | 1 |
| SUD F10–F19 | 1,594 | 24 | $98.8M | $296.9M | $395.7M | 2 |
| MH F30–F48 | 1,593 | 9 | $98.8M†| $111.3M | $210.1M | 3 |
| CVD I20–I51 | 937 | 114 | $58.1M | $1,410.2M | $1,468.3M | 4 |
| COPD J44 | 738 | 28 | $45.8M | $346.4M | $392.2M | 5 |
| Stroke I60–I69 | 511 | 22 | $31.7M | $272.1M | $303.8M | 6 |
| Diabetes E11 | 348 | 16 | $21.6M | $197.9M | $219.5M | 7 |
| TOTAL | 7,533 | 296 | $467.1M | $3,661.5M | $4,128.6M | — |
†MH remission-adjusted (×0.50) gives 941 DALYs = $58.3M HC. Raw MH (1,593 DALYs) shown in table above. VSL is mortality-only; total MH deaths 9 (suicide, overdose complications). CVD ranks #1 on VSL due to 114 deaths × high VSL even with lower DALY rank, illustrating how HC and VSL methods can diverge for diseases with high case fatality vs. high disability burden.
Abbreviations: HC = human capital · VSL = value of statistical life · SUD = substance use disorders · MH = mental health · CVD = cardiovascular disease · COPD = chronic obstructive pulmonary disease · DW = disability weight · DALY = disability-adjusted life year
HC Burden by Condition ($M/yr)
Human capital losses: DALYs × $62,000 GDP/capita
VSL Burden by Condition ($M/yr)
Mortality-based VSL: deaths × $12.4M income-adjusted
VSL Income Adjustment — Gratiot County
The HHS base VSL for 2026 is $13,400,000 (2020 dollars). For Gratiot County, income adjustment uses the elasticity formula: VSLGratiot = VSLnational × (IncomeGratiot / IncomeUS)0.5
= $13,400,000 × 0.9336
= $12,370,062
Gratiot County's median income ($63,556) is about 87% of the US median ($72,875), yielding a VSL 7% below the national figure. This adjustment ensures the VSL reflects Gratiot's local willingness-to-pay, which is lower due to the agricultural wage structure, seasonal employment, and lower per-capita income ($30,221). The income-adjusted VSL is appropriate for county-level grant applications to HRSA, SAMHSA, and MDHHS where local economic context is relevant.
Intervention ROI Estimates
Each DALY averted is worth ~$62,000 in recovered productivity (HC) or ~$12.4M in prevented mortality (VSL). These values anchor cost-effectiveness thresholds for intervention investment decisions and grant applications targeting Gratiot County.
Cancer Screening — Agricultural Worker Outreach
Mobile colorectal, lung, and cervical/breast cancer screening targeting agricultural workers, including Spanish-speaking farmworker outreach. Gratiot's cancer burden is 1,812 DALYs/yr ($112M HC). USPSTF-recommended screening programs typically avert 1 death per 1,000–3,000 screened over 5–10 years. At Gratiot's 8.6% cancer prevalence in an adult population of 33,395, a $400K–$800K outreach program could plausibly identify 15–40 additional cancers/yr at earlier stages. Earlier detection conservatively averts 5–10 DALYs ($310K–$620K HC) per year of program operation.
SUD Harm Reduction — Naloxone + MOUD at Primary Care
Naloxone community distribution and Medication for Opioid Use Disorder (MOUD — buprenorphine/methadone) integrated at Gratiot Medical Center and FQHC sites. SUD burden: 1,594 DALYs/yr ($98.8M HC), 24 deaths/yr. SAMHSA RURAL-OPIOID programs show cost per DALY averted of $8,000–$25,000 — well below the $62,000 HC threshold. A $500K SAMHSA rural grant (RCORP) could reduce SUD deaths by 3–5/yr and avert 40–80 DALYs ($2.5M–$5.0M HC value).
Telehealth Mental Health — Rural MH Access
Gratiot's MH burden: 1,593 DALYs/yr, 26.9% depression prevalence. MMDHD covers Gratiot and 5 other counties — limited per-capita capacity. A telehealth behavioral health program (video-based CBT, medication management) reaching 500–1,000 patients/yr could reduce MH burden by 15–25% in served population. Evidence-based collaborative care models show 60–80 DALYs averted per 1,000 patients treated.
CVD Hypertension Control — FQHC + Pharmacy Sites
CVD accounts for 114/296 deaths (39%) and 937 DALYs. Hypertension prevalence 35.8%, obesity 36.7%. Community Preventive Services Task Force (CPSTF) recommends team-based hypertension control (pharmacist + PA + care coordinator). Program cost $300K–$500K/yr for 1,000 patients; evidence supports 8–12 mmHg SBP reduction → 15–20% CVD mortality reduction → ~17 deaths averted over 10 years = ~$17M VSL saved per program year.
Correctional Re-entry Health — MDOC Partnership
Central Michigan Correctional Facility (Carson City) houses ~2,000 individuals. Post-release mortality rate is 12× higher than general population in first 2 weeks (opioid overdose primary). Medicaid enrollment at release + naloxone kit distribution is the highest-ROI intervention per dollar for this population. A $200K–$400K reentry health program could prevent 3–8 overdose deaths/yr post-release = $37M–$99M VSL value. Also reduces uninsured ED utilization burden on Gratiot Medical Center.