The cost effectiveness of occupational health interventions: prevention of silicosis.

BACKGROUND The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. METHODS To evaluate the cost effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost-effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions namely AMROA (Canada, United States of America), and WPROB1 (China, Korea, Mongolia). RESULTS In both of the two subregions, engineering controls are the most cost effective with ratios varying from 105.89 dollars per healthy year or disability adjusted life year saved in AMROA to approximately 109 dollars in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of engineering controls (EC) looks most attractive. Although dust masks (DM) look attractive in terms of cost, the total efficacy is extremely limited. CONCLUSIONS To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives. Note that this analysis understates health benefits since only silicosis and not all silica-related diseases are considered.