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Practice and potential of economic evaluation of workplace-based interventions for occupational health and safety

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Background: We review economic analyses in studies of workplace-based occupational health and safety interventions in order to report on evidence of their financial merits and assess the quality of application of economic evaluation methodologies. The focus of the review is interventions applicable to an office setting. Materials and Methods: We draw on several systematic reviews to identify studies that consider both the costs and consequences of an intervention, or simply the consequences in monetary terms. Results: In total, we identified 23 studies which we included in our final synthesis. More than half of these studies considered only the consequences in monetary terms, rather than both the costs and consequences associated with the intervention. Conclusions: In reviewing the studies, we identified a number of methodological shortcomings which we discuss in detail. A key message from our review is that there is a need for economic expertise in the multidisciplinary research teams evaluating workplace-based occupational health and safety interventions.

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  1. To address this need, the Institute for Work & Health hosted an International Workshop on Developing Good Practice in the Economic Evaluation of Workplace Interventions for Health and Safety in the spring of 2006.

  2. Full randomization was not feasible due to the possibility of knowledge sharing between the two intervention groups as well as between the intervention groups and the control group.

  3. Loisel et al. [32] undertakes a cost-benefit and cost-effectiveness analysis from the perspective of the public, monopoly insurer in Quebec. Since this public insurer is a not-for-profit organization, savings arising from the reduction in claims cost are generally passed on to employers in the form of lower premiums. In consideration of this fact, cost-benefit analysis might not be the best economic evaluation methodology to employ for this perspective. A more appropriate measure of consequences might be the reduction in disability days or number of claims, which suggests a cost-effectiveness analysis (as opposed to cost-benefit analysis).

  4. A few studies also noted a Hawthorne effect, in which the training component of an intervention increased both awareness and reporting of injuries.

  5. An example where this is not the case is when an organization experiences a reduction in premiums without a comparable reduction in the burden of injuries.

  6. At one level the question is whether a dollar in the public sector is worth more than a dollar in the private sector, given the current distribution of resources between the two sectors. It may be that the current distribution is deemed optimal, in which case incremental transfers to the government have no value at the societal level. There is no easy way to address the issue about the optimal distribution of resources. An alternative approach would be to consider the level of employment that would be sufficient to maintain the optimal level of taxation. An intervention that maintains this optimal level with lower level of labour input would be considered a valued productivity improvement.

  7. The distinction between the sticker price and resource cost is an issue particularly if a broader, societal perspective is taken.

  8. This is due to the nature of the interventions being different, but also because the analytical and computational approaches used by these studies are different.


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Correspondence to Emile Tompa.

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Tompa, E., Dolinschi, R. & de Oliveira, C. Practice and potential of economic evaluation of workplace-based interventions for occupational health and safety. J Occup Rehabil 16, 367–392 (2006).

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