Thursday, December 4, 2014
Evaluate the workplace to identify and prevent other cases of OA
Limited data are available to identify whether the administration of questionnaires or spirometry testing is the beneficial component of medical surveil-lance. Questionnaires (ie, medical history) have been thought to be sensitive but not specific; however, earlier studies found low sensitivity (missed cases of asthma in the absence of reported symptoms; “potential problem of. . . misleading responses”). With respect to the frequency of monitoring, data do not exist to advise a “best” or “most efficient” frequency for surveillance.
Testing conducted every 6 months probably provides as good an outcome as does testing every 3 months and is practicable. A cost-effectiveness (CE) analysis of surveillance for diisocyanate asthma using parameters for inclusion obtained from the literature and an expert panel (including time to diagnosis with and without surveillance) found a favorable CE ratio that supports surveillance for diisocyanate asthma.
The simulation model, which was based on yearly OA surveillance, revealed that surveillance resulted in a benefit over a passive case finding for 100,000 exposed workers over 10 years of 683 fewer disabled workers, 3.3 million more symptom-free days, and 1,831 additional quality-adjusted life-years at an additional cost of $44 million. This analysis estimated that surveillance was cost saving from the societal perspective, but not from the employer perspective, which estimated an incremental CE of $24,000 per quality-adjusted life-year ($13.33 per symptom-free day; $64,000 per case of disability prevented).
Although such findings compare favorably with commonly recommended surveillance tools, the large difference in CE comparing societal and employer perspectives supports the argument that mandatory regulation may be the most effective way to implement surveillance for certain occupational diseases.