Abstract

Objectives
Use of cost-benefit analysis in occupational health increases insight into the intervention strategy that maximises the cost-benefit ratio. This study presents a methodological framework identifying the most important elements of a cost-benefit analysis for occupational health settings. One of the main aims of the methodology is to evaluate cost-benefit ratios for different stakeholders (employers, employees and society). The developed methodology was applied to two intervention strategies focused on reducing respiratory diseases.

Methods
A cost-benefit framework was developed and used to set up a calculation spreadsheet containing the inputs and algorithms required to calculate the costs and benefits for all cost elements. Inputs from a large variety of sources were used to calculate total costs, total benefits, net costs and the benefit-to-costs ratio for both intervention scenarios.

Results
Implementation of a covenant intervention program resulted in a net benefit of €16?848?546 over 20 years for a population of 10?000 workers. Implementation was cost-effective for all stakeholders. For a health surveillance scenario, total benefits resulting from a decreased disease burden were estimated to be €44?659?352. The costs of the interventions could not be calculated.

Overall, there was an estimated benefit of Euro 44,659,352 for the full 20-year period for a population of 10,000 workers. A total of 4,200 individual interventions was estimated. Based on these figures the average cost of an individual intervention needs to remain below Euro 10,000 per intervention for there to be a net benefit. If the interventions are fully paid for by the employers, the average cost must remain below Euro 4,650 per individual intervention so as not to exceed the employer’s benefits. However, it should be acknowledged that in many cases workplace changes are likely to affect more than one worker and changes will also impact on future workers, which further complicates the assessment of intervention costs at an individual level.

Conclusion
This study provides important insights for developing effective intervention strategies in the field of occupational medicine. Use of a model based approach enables investigation of those parameters most likely to impact on the effectiveness and costs of interventions for work related diseases. Our case study highlights the importance of considering different perspectives (of employers, society and employees) in assessing and sharing the costs and benefits of interventions.

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