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Objective: This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders. Setting: Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries. Participants: 72 out of 82 Flemish sports federations participated. Intervention: Insurance statistics from 2003 were used to determine the overall rate of injury and injury localisations. Using these data, the medical direct cost and the impact sports injuries have on indirect costs were estimated. The indirect costs were determined by multiplying the days of absence from work with the daily cost resulting from a loss of production, being €200. Main outcome: The total direct medical cost extrapolated for the Flemish sports participants was €15 027 423, which amounted to 0.07% to 0.08% of the total budget spent on healthcare. The indirect cost extrapolated for the Flemish sports participants was €111 420 813, which is about 3.4% of the costs arising from absenteeism from work. Results: Of the 14 in-depth analysed sports, the rate of injury was highest in European team handball (8.96%; 95% confidence interval (Cl) 8.95-8.96) and lowest in swimming (0.62%; 95% Cl 0.62-0.62). The highest direct medical cost was found for anterior cruciate ligament (ACL) injuries (€1358 per injury) and the lowest for foot injuries (€52 per injury). Conclusion: The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures to be made. [ABSTRACT FROM AUTHOR]