Dog undescended testicle surgery cost: A Comprehensive Guide 2023

Dog undescended testicle surgery, also known as cryptorchidism surgery, is a critical procedure aimed at addressing a common reproductive issue in male dogs. Understanding the factors that contribute to the dog undescended testicle surgery cost is essential for responsible pet ownership, as it allows owners to make informed decisions regarding their beloved companions.

In a broad estimation, the financial outlay for such a procedure typically falls within the range of $500 to $2,000. The size of the dog plays a pivotal role in determining the overall cost of the surgery. Larger dogs generally entail higher expenses due to the greater quantities of anesthesia and supplies required to accommodate their size.

Moreover, the location of the undescended testicle holds significance. If the testicle resides within the abdomen, the surgical procedure becomes more intricate and necessitates a larger incision for extraction, potentially leading to heightened expenses compared to cases where the testicle is located within the scrotum.

Another pivotal factor is the type of surgical intervention chosen. Within the realm of undescended testicle surgery for dogs, two primary options exist: scrotal transposition and orchiectomy. The former involves relocating the testicle to the scrotum and tends to be less invasive, thus often resulting in a lower price point.

What factors influence the cost of dog undescended testicle surgery?

Dog undescended testicle surgery cost

The cost of dog undescended testicle surgery, also known as cryptorchidism surgery, can vary depending on several factors. These factors include:

  1. Location: The cost of veterinary services can significantly differ based on the geographical location. Veterinarian services tend to be more expensive in urban areas and affluent neighborhoods.
  2. Veterinary Clinic: The type of veterinary clinic or hospital you choose will impact the cost. Specialty or referral hospitals often charge more for their services due to their specialized expertise and equipment.
  3. Surgeon’s Expertise: The experience and skill level of the veterinarian performing the surgery can influence the cost. Highly skilled and experienced surgeons might charge more for their services.
  4. Diagnostic Tests: Prior to the surgery, diagnostic tests such as blood work, ultrasound, and X-rays might be required to assess the health of your dog and locate the undescended testicle. These tests can contribute to the overall cost.
  5. Anesthesia and Medications: Anesthesia administration, pain management medications, and post-operative care medications are additional costs associated with the surgery.
  6. Length and Complexity of Surgery: The surgical procedure’s complexity, the time it takes to complete, and any potential complications that might arise during the surgery can impact the overall cost.
  7. Hospitalization and Recovery: If your dog needs to stay at the veterinary clinic for observation and recovery, the length of hospitalization can add to the cost.
  8. Follow-up Appointments: Post-operative check-ups and follow-up appointments might be necessary to ensure your dog’s recovery is progressing well. These appointments can incur additional charges.
  9. Breed and Size of Dog: Larger dogs might require more anesthesia and post-operative care, which can contribute to a higher cost. Additionally, certain breeds are more prone to cryptorchidism, and the difficulty of the surgery can vary based on breed-specific factors.
  10. Additional Procedures: In some cases, if the undescended testicle is found to be cancerous or if there are complications during surgery, additional procedures might be needed, leading to increased costs.
  11. Clinic Facilities: Veterinary clinics with advanced facilities and equipment might charge more due to the availability of modern medical technologies.
  12. Geographic Pricing Variation: Different regions or cities might have varying cost structures for veterinary services, influenced by factors such as cost of living and demand for services.

It’s essential to consult with your veterinarian to get an accurate estimate of the cost based on your specific situation.

Are there different surgical techniques available for correcting undescended testicles in dogs?

There are different surgical techniques available for correcting undescended testicles in dogs. The choice of technique depends on the specific situation, the location of the undescended testicle, and the veterinarian’s expertise. Here are some of the commonly used surgical techniques:

  1. Orchiopexy: This is the most common surgical procedure used to correct undescended testicles. In this procedure, the veterinarian makes an incision in the inguinal canal (the area in the groin where the testicle should have descended) or the abdominal wall. The testicle is located and then secured in its proper position in the scrotum. Stitches or sutures are used to hold the testicle in place while it heals.
  2. Inguinal or Abdominal Approach: Depending on the location of the undescended testicle, the surgeon might choose to access it through the inguinal canal (inguinal approach) or by making an incision in the abdominal wall (abdominal approach). The choice of approach is determined by the surgeon’s evaluation of the testicle’s location and the best way to access and secure it.
  3. Laparoscopic Orchiopexy: Laparoscopy is a minimally invasive surgical technique where small incisions are made, and a tiny camera and surgical instruments are used to perform the procedure. This technique is less invasive and can lead to faster recovery times, but it requires specialized equipment and training.
  4. Exploratory Laparotomy: If the testicle cannot be located through external manipulation, an exploratory laparotomy might be performed. This involves making an incision into the abdominal cavity to directly visualize and locate the undescended testicle. Once located, it can be brought down into the scrotum and secured.
  5. Unilateral vs. Bilateral Surgery: If both testicles are undescended, surgery might be needed on both sides. The surgical techniques used for bilateral cases are similar to those used for unilateral cases, but the complexity and recovery time might increase.

The choice of technique will depend on factors such as the dog’s age, breed, overall health, the specific location of the undescended testicle, and the surgeon’s preference and experience. It’s important to consult with a veterinarian who specializes in surgery or reproductive health to determine the best approach for your dog.

How much does the average dog undescended testicle surgery cost?

The cost of dog undescended testicle surgery can vary widely depending on the factors mentioned earlier, such as location, type of clinic, surgeon’s expertise, diagnostic tests, anesthesia, and more. On average, the cost for this type of surgery can range from $300 to $1,500 or more.

However, it’s important to note that this is just a general estimate and the actual cost can be higher or lower based on the specific circumstances.

In areas with a higher cost of living or in specialty veterinary clinics, the cost might be towards the higher end of the range. Conversely, in more rural or less affluent areas, the cost might be on the lower end. The presence of additional procedures, complications, or special requirements can also influence the final cost.

To get an accurate estimate for your dog’s surgery, it’s recommended to consult with a local veterinarian. They can provide you with a detailed breakdown of the expected costs based on your dog’s breed, size, health condition, and the specific clinic or hospital you plan to use.

Do veterinary clinic locations affect the price of the surgery?

Dog undescended testicle surgery cost

The location of a veterinary clinic can indeed affect the price of surgery, including dog undescended testicle surgery. The cost of veterinary services can vary significantly based on the geographical region and the local economic factors. Here’s how location can impact the price:

  1. Cost of Living: Veterinary clinics located in areas with higher costs of living, such as major cities or affluent neighborhoods, tend to have higher overhead costs, including rent, utilities, and staff salaries. As a result, these clinics might charge higher fees for their services.
  2. Urban vs. Rural Areas: Veterinary clinics in urban areas often have higher operating costs due to higher real estate prices and increased competition for resources. In rural areas, where the cost of living is generally lower, veterinary services might be more affordable.
  3. Regional Economic Variation: Different regions or states within a country might have varying economic conditions. This can lead to differences in pricing for veterinary services based on factors like income levels, local industry, and economic stability.
  4. Supply and Demand: Areas with a high demand for veterinary services and a limited number of clinics might have slightly higher prices due to the availability of specialized care.
  5. Access to Specialists: Some regions might have more specialized veterinary hospitals or clinics, which could lead to higher costs for procedures like undescended testicle surgery due to the expertise and equipment available.
  6. Travel Costs: If you need to travel a significant distance to access a specific veterinary clinic, you might need to factor in additional costs for transportation, lodging, and other related expenses.

It’s essential to keep in mind that while location plays a role in the cost, the quality of care and the expertise of the veterinary team are paramount when making decisions about your pet’s health.

What are the potential complications that may lead to additional costs?

Several potential complications can arise during or after dog undescended testicle surgery that may lead to additional costs. While these complications are not guaranteed to occur, it’s important to be aware of them and be prepared for the possibility of additional expenses. Some potential complications include:

  1. Infection: Surgical sites can become infected, requiring additional treatment with antibiotics or wound care. This might necessitate additional veterinary visits and medication costs.
  2. Hematoma or Seroma Formation: Hematomas (collections of blood) or seromas (collections of fluid) can form at the surgical site. These might need to be drained, which can involve additional procedures and associated costs.
  3. Suture Complications: If the sutures (stitches) used to close the incision sites become loose, infected, or cause irritation, they might need to be addressed. This could involve suture removal, replacement, or additional wound care.
  4. Delayed Healing: Some dogs might experience delayed wound healing or poor incision healing. Additional treatments, such as bandaging, topical medications, or more frequent follow-up visits, might be required.
  5. Adverse Reaction to Anesthesia: In rare cases, dogs can have adverse reactions to anesthesia, leading to complications that require monitoring, additional medications, and potentially extended hospitalization.
  6. Testicular Atrophy: If the undescended testicle is located and brought down into the scrotum during surgery, there’s a chance that it might not function properly due to its abnormal development. This could lead to subsequent health issues or the need for further interventions.
  7. Surgical Site Dehiscence: In some cases, the incision might reopen or split, leading to the need for sutures or staples to be replaced and potential additional surgery.
  8. Scrotal Swelling or Bruising: Some post-operative swelling or bruising around the scrotal area can occur, requiring monitoring and potentially additional medications or treatments.
  9. Complications Related to E-collar Use: After surgery, dogs might need to wear an Elizabethan collar (cone) to prevent them from licking or biting the incision sites. However, complications like skin irritation, discomfort, or difficulty eating or drinking can arise, requiring adjustments or alternatives.
  10. Unplanned Hospitalization: If the dog’s recovery is slower than expected or if complications arise, extended hospitalization might be necessary. This can lead to increased boarding costs and additional veterinary care expenses.

It’s important to have open communication with your veterinarian before and after the surgery. They can help you understand the potential risks, complications, and associated costs, and provide guidance on how to monitor your dog‘s recovery.

Additionally, having a financial plan in place to cover potential additional costs is a wise approach to ensure the best care for your pet.

Are there pre-surgery consultation and examination fees involved?

Typically, there are pre-surgery consultation and examination fees involved when undergoing a medical procedure or surgery. These fees cover the costs associated with the healthcare provider’s time, expertise, and resources used during the consultation and examination process.

During the pre-surgery consultation, the healthcare provider will assess your medical history, perform a physical examination, discuss the surgical procedure, and address any questions or concerns you might have.

These fees can vary depending on factors such as the complexity of the procedure, the reputation and experience of the healthcare provider, the location of the medical facility, and the specific healthcare system in place.

It’s important to inquire about these fees in advance and clarify with your healthcare provider or their administrative staff to have a clear understanding of the costs associated with the pre-surgery consultation and examination.

Keep in mind that these fees are separate from the actual surgical costs, which encompass the expenses related to the surgery itself, such as anesthesia, surgical equipment, operating room facilities, and post-operative care.

What expenses should be expected for anesthesia and medications?

For anesthesia and medications associated with surgery, you can expect several expenses. It’s important to note that the specific costs can vary widely based on factors such as the type of surgery, the anesthesia method used, the medications required, the healthcare facility, and your geographical location.

Here’s a general overview of the expenses you might encounter:

  1. Anesthesia Fees: Anesthesia is administered to ensure you’re comfortable and pain-free during the surgery. The cost of anesthesia can depend on the type used:
    • Local Anesthesia: This is often the least expensive option and involves numbing only a specific area of the body. Costs for local anesthesia are generally lower.
    • Regional Anesthesia: This involves numbing a larger portion of the body, such as an entire limb. Costs can be higher than local anesthesia.
    • General Anesthesia: This renders you unconscious and requires an anesthesiologist’s presence throughout the surgery. General anesthesia tends to be the most expensive option due to the specialized personnel and monitoring equipment involved.
  2. Anesthesia Provider’s Fees: An anesthesiologist or a certified nurse anesthetist administers anesthesia and monitors your vital signs throughout the surgery. Their services come with associated fees that can vary depending on the complexity and duration of the surgery.
  3. Medication Costs: Medications are essential for pain management and recovery after surgery. These medications can include pain relievers, antibiotics to prevent infection, and medications to manage potential side effects. The cost of these medications can vary based on the type and dosage prescribed by your healthcare provider.
  4. Operating Room Fees: Part of the operating room expenses may cover the equipment, supplies, and medications used during the surgery, including anesthesia drugs.
  5. Post-Anesthesia Care: After the surgery, you may require continued monitoring in a post-anesthesia care unit (PACU). The costs associated with this monitoring and any additional medications or interventions can contribute to the overall expenses.
  6. Facility and Provider Charges: Different medical facilities and healthcare providers may have varying fee structures. It’s essential to clarify with your healthcare provider or the facility’s billing department what charges are included in your anesthesia and medication expenses.
  7. Insurance Coverage: Depending on your health insurance coverage, some or all of these expenses may be covered. It’s important to check with your insurance provider about the extent of coverage for anesthesia, medications, and associated costs.
  8. Out-of-Pocket Costs: If you have a deductible, copayments, or coinsurance as part of your insurance plan, you will likely be responsible for a portion of the anesthesia and medication expenses.

To accurately estimate the expenses for anesthesia and medications, you should discuss these aspects with your healthcare provider and your insurance company. They can provide you with a better understanding of the potential costs you might incur for these essential aspects of your surgery.

How much does post-operative care and follow-up cost?

Dog undescended testicle surgery cost

The cost of post-operative care and follow-up visits can vary depending on factors such as the type of surgery, the complexity of the procedure, the healthcare provider’s fees, the location of the medical facility, and the specific healthcare system in place.

Here’s an overview of the potential expenses associated with post-operative care and follow-up:

  1. Post-Operative Visits: After surgery, you will likely need to have follow-up appointments with your surgeon or other healthcare providers involved in your care. These appointments are important for monitoring your recovery, addressing any complications, and ensuring that your healing process is progressing as expected.
  2. Diagnostic Tests: Depending on your surgical procedure, your healthcare provider might order follow-up diagnostic tests such as X-rays, MRIs, blood tests, or other imaging studies to monitor your healing and assess the success of the surgery.
  3. Medication Costs: You may be prescribed medications for pain management, infection prevention, and other aspects of your recovery. The cost of these medications can contribute to your post-operative care expenses.
  4. Wound Care Supplies: If your surgery involves incisions or wounds that require special care, there may be additional expenses related to wound dressings, ointments, and other supplies.
  5. Rehabilitation and Physical Therapy: Depending on the type of surgery, you might need rehabilitation or physical therapy sessions to aid in your recovery. These sessions can have associated costs.
  6. Transportation and Accommodation: If you need to travel for follow-up appointments or if your healthcare facility is not nearby, you should consider potential transportation and accommodation expenses.
  7. Healthcare Provider’s Fees: Each follow-up visit may come with associated fees charged by the healthcare provider. These fees can vary based on the provider’s specialization, experience, and the complexity of the visit.
  8. Insurance Coverage: The extent to which your post-operative care and follow-up expenses are covered by insurance depends on your specific insurance plan. It’s important to contact your insurance provider to understand what aspects of post-operative care are covered and what portion you might be responsible for paying out of pocket.
  9. Out-of-Pocket Costs: If you have a deductible, copayments, or coinsurance as part of your insurance plan, you will likely need to cover a portion of the post-operative care expenses.

To get a clear understanding of the potential costs for post-operative care and follow-up, it’s recommended to communicate with your healthcare provider’s billing department and your insurance company.

Are there any affordable options, such as nonprofit or low-cost clinics?

There are often affordable options available for post-operative care and follow-up through nonprofit organizations, low-cost clinics, and community health centers. These resources are designed to provide healthcare services to individuals who may have limited financial means.

Here are some options you can explore:

  1. Nonprofit Organizations: Many nonprofit organizations and charities offer medical services, including post-operative care and follow-up, at reduced or no cost. These organizations often focus on specific medical conditions or populations. Examples include the American Cancer Society, American Heart Association, and various disease-specific foundations.
  2. Community Health Centers: Community health centers are federally funded clinics that provide comprehensive healthcare services to underserved populations, regardless of their ability to pay. They offer a wide range of medical services, including post-operative care and follow-up. These centers often have a sliding fee scale based on income, making them affordable for those with limited financial resources.
  3. Free and Low-Cost Clinics: Many areas have free or low-cost clinics that provide basic medical services to individuals in need. These clinics might be run by local governments, religious organizations, or nonprofit groups. While the range of services can vary, they often provide essential post-operative care and follow-up.
  4. Teaching Hospitals: Teaching hospitals associated with medical schools often offer a range of medical services, including post-operative care, at lower costs. These hospitals are used for training medical students and residents, which can make their services more affordable.
  5. Telemedicine Services: Some telemedicine platforms offer affordable virtual consultations with healthcare providers. While they might not cover all aspects of post-operative care, they can be a cost-effective option for follow-up appointments and consultations for minor issues.
  6. Local Health Departments: Government-operated health departments may offer post-operative care services at reduced costs, particularly for individuals who qualify for certain assistance programs.
  7. Charitable Clinics and Voluntary Organizations: There are charitable clinics and voluntary organizations that provide healthcare services to those in need. These clinics might be run by religious groups, volunteer networks, or local charities.

When seeking affordable post-operative care options, it’s important to do some research in your local area to identify the available resources. You can search online, contact local healthcare providers, reach out to your local health department, or inquire at community centers.

Additionally, nonprofit organizations and patient advocacy groups related to your medical condition may have information about affordable care options.

Does insurance typically cover dog undescended testicle surgery?

Whether insurance covers the surgery to correct an undescended testicle in a dog can vary based on the specific insurance policy and the terms and conditions set by the insurance provider. Pet insurance policies can vary significantly in terms of coverage, exclusions, and limitations.

Here are some points to consider:

  1. Type of Coverage: Some pet insurance policies offer coverage for surgical procedures, while others might have specific exclusions for certain conditions, including pre-existing conditions. It’s important to review the policy’s coverage details to understand whether undescended testicle surgery is covered.
  2. Pre-existing Conditions: If the undescended testicle is a pre-existing condition, meaning it was present or diagnosed before you purchased the insurance policy, it might not be covered. Many pet insurance policies do not cover pre-existing conditions, so it’s crucial to clarify this with your insurance provider.
  3. Waiting Periods: Some pet insurance policies have waiting periods before certain conditions are covered. If you’re considering surgery for an undescended testicle and you have recently obtained pet insurance, it’s important to understand whether the waiting period applies to this specific procedure.
  4. Policy Exclusions: Review the policy’s terms and conditions to check if there are any exclusions related to specific procedures or conditions. Some policies might exclude coverage for certain genetic or hereditary conditions, which could potentially include undescended testicles.
  5. Coverage Limits: Even if the surgery is covered, some policies have limits on how much they will reimburse for specific procedures. Make sure to understand the coverage limits and any applicable deductibles or co-pays.
  6. Pre-authorization: Some insurance policies require pre-authorization before undergoing certain procedures. Contact your insurance provider to understand their requirements for pre-authorization and claim submission.
  7. Documentation: To have the best chance of obtaining coverage, you’ll likely need to provide thorough documentation of your dog‘s medical history, diagnosis, and the necessity of the surgery.

It’s important to thoroughly read and understand your pet insurance policy before proceeding with any medical procedures. If you’re unsure whether the undescended testicle surgery would be covered, contact your insurance provider directly. They can provide you with the specific information you need about coverage, reimbursement, and any associated costs.

Is neutering included in the surgery cost, and what are its benefits?

Dog undescended testicle surgery cost

Neutering is a surgical procedure that involves the removal of a male animal’s testicles, typically rendering them sterile. While the cost of neutering can vary based on factors such as location, veterinarian fees, and the size of the animal, it is often an additional procedure and not usually included in the surgery cost for other medical issues.

Neutering is a separate surgical procedure with its own associated costs.

The benefits of neutering, also known as castration, can be significant and include:

  1. Population Control: One of the primary reasons for neutering is to help control the pet population. By neutering male animals, they are unable to reproduce, which helps prevent unwanted litters of puppies and kittens. This is particularly important in reducing the number of homeless animals.
  2. Behavioral Benefits: Neutering can lead to behavioral improvements in some animals. It can help reduce or eliminate certain undesirable behaviors, such as aggressive tendencies, territorial marking (spraying urine), and roaming behavior in search of a mate.
  3. Health Benefits: Neutering can have health benefits for male animals. It reduces the risk of certain health issues, such as testicular tumors and certain prostate problems. It can also help prevent certain types of cancers that are related to the reproductive organs.
  4. Reduced Aggression: Neutering can often lead to a reduction in aggressive behaviors, making interactions with other animals and people more harmonious.
  5. Reduced Roaming: Neutered animals are less likely to roam in search of a mate, which can help keep them safer from accidents and potential dangers.
  6. Avoiding Unwanted Pregnancies: Neutering prevents unplanned pregnancies and the associated challenges of caring for and finding homes for offspring.
  7. Cost Savings: While there is an upfront cost to the surgery, neutering can lead to long-term cost savings by reducing the likelihood of certain health issues and behavioral problems that might require veterinary care or behavior training.

It’s important to discuss the benefits and considerations of neutering with your veterinarian. They can help you make an informed decision based on your pet’s specific situation, health status, and behavior.

Are there financial assistance programs available for the surgery?

There are many financial assistance programs available for surgery. Here are a few examples:

  • Hospital financial assistance programs. Many hospitals have their own financial assistance programs that can help patients who are unable to afford the cost of surgery. These programs typically consider factors such as income, assets, and family size when determining eligibility.
  • Government programs. The government offers a number of programs that can help pay for surgery, such as Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP). These programs have eligibility requirements, so it is important to check to see if you qualify.
  • Nonprofit organizations. There are many nonprofit organizations that provide financial assistance for surgery. These organizations typically focus on helping specific populations, such as low-income individuals, uninsured people, or people with certain medical conditions.

What are the long-term savings of performing the surgery?

The long-term savings of performing surgery can vary depending on the type of surgery and the patient’s individual circumstances. However, in general, surgery can lead to long-term savings in the following areas:

  • Reduced healthcare costs. Surgery can reduce the need for future medical treatment, such as hospitalization, medications, and rehabilitation. This can lead to significant long-term savings in healthcare costs.
  • Increased productivity. Surgery can improve a patient’s ability to work and participate in activities of daily living. This can lead to increased productivity and earnings, which can also save money in the long run.
  • Improved quality of life. Surgery can improve a patient’s quality of life by reducing pain, improving mobility, and restoring function. This can lead to a more active and independent lifestyle, which can have a number of benefits, both financial and non-financial.

Of course, the cost of surgery must also be considered. In some cases, the cost of surgery may outweigh the long-term savings. However, for many patients, the long-term savings of surgery can make it a worthwhile investment.

Can the surgery cost vary depending on the dog’s size or breed?

The surgery cost can vary depending on the dog’s size or breed. This is because larger dogs typically require more anesthesia, more surgery time, more time to clip the surgical area, more suture materials, more pain medication, etc.

For example, spaying or neutering a large breed dog like a Great Dane will likely cost more than performing the same procedure on a smaller dog like a Chihuahua.

In addition, some breeds of dogs are more prone to certain health conditions that require surgery. For example, hip dysplasia is a common condition in large breed dogs, and surgery to repair a damaged hip can be expensive.

It is important to talk to your veterinarian about the specific cost of surgery for your dog. They will be able to give you an estimate based on your dog’s size, breed, and the type of surgery needed.

How do veterinarians determine the total cost of dog undescended testicle surgery?
Veterinarians determine the total cost of dog undescended testicle surgery based on a number of factors, including:

  • The size and breed of the dog. Larger dogs typically require more anesthesia, more surgery time, and more suture materials, which can all drive up the cost of surgery. Some breeds of dogs are also more prone to certain health conditions that require surgery, such as hip dysplasia, which can also increase the cost of surgery.
  • The location of the veterinary clinic. The cost of surgery can vary depending on the location of the veterinary clinic. For example, surgery in a large city is likely to be more expensive than surgery in a rural area.
  • The experience of the veterinarian. The cost of surgery can also vary depending on the experience of the veterinarian. A more experienced veterinarian may charge more for surgery, but they may also be more skilled and have a better success rate.
  • The type of anesthesia used. The type of anesthesia used can also affect the cost of surgery. General anesthesia is more expensive than local anesthesia, but it is also safer for most dogs.
  • The cost of medications. The cost of medications can also add to the cost of surgery. Some medications, such as antibiotics, are necessary for all dogs after surgery. Other medications, such as pain medication, may only be needed for some dogs.
  • The urgency of the surgery. If the surgery is urgent, such as if the dog is in pain or if there is a risk of infection, the cost of surgery may be higher.


Dog undescended testicle surgery cost range from $300 to $1500, depending on factors such as the location, the veterinarian’s experience, and any additional procedures like neutering. While financial considerations are important, it’s crucial to weigh them against the long-term health benefits for your pet.

Undescended testicle surgery not only mitigates potential health risks but also addresses future reproductive and behavioral concerns. By consulting with a veterinarian and understanding the costs involved, pet owners can make informed decisions that prioritize their dog‘s well-being and overall quality of life.