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Surveillance for isocyanate asthma: a model based cost effectiveness analysis.

Authors
Wild-DM; Redlich-CA; Paltiel-AD
Source
Occup Environ Med 2005 Nov; 62(11):743-749
NIOSHTIC No.
20029036
Abstract
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.
Keywords
Isocyanates; Bronchial-asthma; Models; Occupational-diseases; Diseases; Mathematical-models; Simulation-methods; Occupational-exposure; Workers; Disabled-workers; Surveillance-programs; Pulmonary-system-disorders
Contact
Dr D Wild, Department of Internal and Preventive Medicine, Griffin Hospital, 130 Division Street, Derby, CT 06418, USA
CODEN
OEMEEM
Publication Date
20051101
Document Type
Journal Article
Email Address
dorothea.wild@yale.edu
Funding Amount
2634676
Funding Type
Grant
Fiscal Year
2006
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-003457
Issue of Publication
11
ISSN
1351-0711
Priority Area
Disease and Injury: Asthma and Chronic Obstructive Pulmonary Disease
Source Name
Occupational and Environmental Medicine
State
CT
Performing Organization
Yale University, New Haven, Connecticut
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