The cost effectiveness of occupational health interventions: Preventing occupational back pain
The cost effectiveness of occupational health interventions: Preventing occupational back pain
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DOI：
10.1002/ajim.20193
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发表时间：
2005-12-01
影响因子：
3.5
通讯作者：
Levenstein, C
中科院分区：
文献类型：
--
作者：
Lahiri, S;Markkanen, P;Levenstein, C
背景 职业性背痛给社会带来巨大损失，并伴随着经济损失；必须评估干预措施的成本效益，以减少工作中相关的人体工学压力源。本研究估计并评估了世界卫生组织（WHO）定义的世界各次区域预防职业性背痛的具体干预措施的平均和增量成本效益比（CER）。方法从文献中选择了四种背痛干预措施：培训（T）、工程控制（EC）、工程控制和培训（EC＆T）以及全面的人体工程学计划（EP）进行评估。 WHO CHOICE 倡议项目开发的 100 年时间范围模拟模型用于估计健康年干预措施的有效性。世卫组织所有次区域的干预成本均进行了调整。结果 在所有次区域中，培训是最具成本效益的，但 CER 各不相同。埃及、伊拉克、摩洛哥、也门 (EMROD) 次区域每健康生命年收益从 74 美元增至加拿大和美国 (AMROA) 次区域约 567 美元。培训被认为非常具有成本效益，并且是资源稀缺地区的首选。但培训总体效果较低。尽管工程控制和全面人体工程学干预等其他干预措施相对昂贵，但通过这些干预措施对健康结果的增加要高得多。对于世界上大多数工业化地区来说，培训和其他工程控制和全面人体工程学干预的 CER 差异相对较小。从不同次区域的 CER 排名和增量 CER 可以清楚地看出，在世界上大多数工业化地区，额外资源（如果可用）应直接用于完整的人体工程学计划。 结论 基于 CER 的模型结果表明，工人培训是降低背痛/受伤发生率的低成本、可行的第一步。然而，每个地区不同干预措施的所有平均 CER 都在其人均 GDP 估计范围内 [世界银行，2001 年]。根据世界卫生组织宏观经济与健康委员会的说法，任何成本低于人均国内生产总值三倍的干预措施都应被认为是值得的，并且物有所值。 [世界卫生组织，2002]。考虑到这一标准，工程控制干预措施以及完整的人体工程学计划对于世卫组织所有次区域来说看起来都非常具有成本效益。是。 J.工业医学。 48:515-529, 2005。(c) 2005 Wiley-Liss, Inc.
Background Occupational back pain exacts atoll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world.Methods Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions.Results In all of the subregions, training was the most cost-effective with CERs varying. from $74 per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately $567 in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher The difference in the CERs for training and other engineering controls and-full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different, subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program.Conclusions The model results based on CERs show that worker training is a low cost, feasible first step toward reducing,back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money. [WHO, 2002]. Given this criterion, the engineering controls interventions- as well as the full ergonomics program look very cost effective for all of the WHO subregions. Am. J. Ind. Med. 48:515-529, 2005. (c) 2005 Wiley-Liss, Inc.