Surveillance for Isocyanate Asthma: A Model Based Cost Effectiveness Analysis

Details

• Personal Author:
  Paltiel AD ; Redlich CA ; Wild DM
• Description:
  Because logistical and financial obstacles impede using large prospective cohort studies, surveillance decisions in occupational settings must often be made without evidence of relative benefits and costs. Using the example of isocyanate induced asthma, the most commonly reported immune mediated occupational asthma, the authors developed a model based approach to evaluate the costs and benefits of surveillance from both an employer and a societal perspective. The authors used a mathematical simulation model of isocyanate asthma to compare annual surveillance to passive case finding. Outcome measures included symptom free days (SFD), quality adjusted life years (QALY), direct costs, productivity losses, and incremental cost effectiveness ratio (CER), measured from the employer and the societal perspectives. Input data were obtained from a variety of published sources. For 100,000 exposed workers, surveillance resulted in 683 fewer cases of disability over 10 years. Surveillance conferred benefits at an incremental cost of 24,000 dollars/QALY (employer perspective; 13.33 dollars/SFD) and was cost saving from the societal perspective. Results were sensitive to assumptions about sensitisation rate, removal rates, and time to diagnosis, but not to assumptions about therapy costs and disability rates. Baseline results placed the CER for surveillance for isocyanate asthma within the acceptable range. Costs from the societal and employer perspective differed substantially with a more attractive CER from the societal perspective, suggesting opportunities for employer/societal cost sharing. The analysis demonstrates the value of a model based approach to evaluate the cost effectiveness of surveillance programmes for isocyanate asthma, and to inform shared decision making among clinicians, patients, employers, and society. Such a modeling approach may be applicable to surveillance programmes for other work related conditions. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Isocyanates Occupational Diseases Occupational Exposure Occupational Health Respiratory Tract Diseases Safety
• Keywords:
  Bronchial-asthma Disabled-workers Diseases Mathematical-models Models Occupational-diseases Occupational-exposure Pulmonary-system-disorders Simulation-methods Surveillance-programs Workers

  More +
• ISSN:
  1351-0711
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  62
• Issue:
  11
• NIOSHTIC Number:
  nn:20029036
• Citation:
  Occup Environ Med 2005 Nov; 62(11):743-749
• Contact Point Address:
  Dr D Wild, Department of Internal and Preventive Medicine, Griffin Hospital, 130 Division Street, Derby, CT 06418, USA
• Email:
  dorothea.wild@yale.edu
• Federal Fiscal Year:
  2006
• NORA Priority Area:
  Disease and Injury: Asthma and Chronic Obstructive Pulmonary Disease
• Performing Organization:
  Yale University, New Haven, Connecticut
• Peer Reviewed:
  True
• Start Date:
  19970901
• Source Full Name:
  Occupational and Environmental Medicine
• End Date:
  20020831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:25ce3b3e8a5c56bd6de5286f7dfa36d7e77abdeaf3d9beb55d6cba4d4a775a6b26431b7c34e980490ff78075ca206573bb3fc865a08938ad08ef7099653f5d9d
• Download URL:
  https://stacks.cdc.gov/view/cdc/190110/cdc_190110_DS1.pdf
• File Type:
  [PDF - 104.17 KB ]