title: Cost-benefit analysis in occupational health: a comparison of intervention scenarios for occupational asthma and rhinitis among bakery workers.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: TNO, Department of Quality and Safety, PO Box 360, 3700 AJ Zeist, The Netherlands. tim.meijster@tno.nl
authors.forename: Tim
authors.initials: T
authors.lastname: Meijster
authors.forename: Birgit
authors.initials: B
authors.lastname: van Duuren-Stuurman
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.forename: Remko
authors.initials: R
authors.lastname: Houba
authors.forename: Ernst
authors.initials: E
authors.lastname: Koningsveld
authors.forename: Nicholas
authors.initials: N
authors.lastname: Warren
authors.forename: Erik
authors.initials: E
authors.lastname: Tielemans
mesh_terms: D001249:Asthma / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D018803:Models, Economic; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000191:economics* / Q000517:prevention & control; D009786:Occupational Health Services / Q000191:economics*; D012220:Rhinitis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control