title: Cost-effectiveness of workplace wellness to prevent cardiovascular events among U.S. firefighters.
abstract: The leading cause of death among firefighters in the United States (U.S.) is cardiovascular events (CVEs) such as sudden cardiac arrest and myocardial infarction. This study compared the cost-effectiveness of three strategies to prevent CVEs among firefighters.
  
  
  
  We used a cost-effectiveness analysis model with published observational and clinical data, and cost quotes for physiologic monitoring devices to determine the cost-effectiveness of three CVE prevention strategies. We adopted the fire department administrator perspective and varied parameter estimates in one-way and two-way sensitivity analyses.
  
  
  
  A wellness-fitness program prevented 10% of CVEs, for an event rate of 0.9% at $1440 over 10-years, or an incremental cost-effectiveness ratio of $1.44 million per CVE prevented compared to no program. In one-way sensitivity analyses, monitoring was favored if costs were < $116/year. In two-way sensitivity analyses, monitoring was not favored if cost was ≥ $399/year. A wellness-fitness program was not favored if its preventive relative risk was >0.928.
  
  
  
  Wellness-fitness programs may be a cost-effective solution to preventing CVE among firefighters compared to real-time physiologic monitoring or doing nothing.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, 3600 Forbes Avenue, Iroquois Bldg., Suite 400A, Pittsburgh, PA, 15261, USA. pattersonpd@upmc.edu.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Patterson
authors.affiliation: Section of Decision Sciences, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.affiliation: Department of Exercise and Nutrition Sciences, Emergency Responder Human Performance Lab, University at Buffalo, The State University of New York, Buffalo, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hostler
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D061388:Firefighters; D006293:Health Promotion / Q000191:economics*; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D016272:Occupational Health / Q000191:economics / Q000592:standards*; D014481:United States / Q000453:epidemiology; D017132:Workplace / Q000592:standards*
keywords: Cardiovascular events; Cost-Effectiveness; Physical fitness; Wellness