Multi-Study Spotlight: Economic Evaluations of Occupational Health and Safety

Spotlight on article published in

Scandinavian Journal of Work, Environment & Health

IBI Spotlights call attention to important health and productivity findings from peer-reviewed work by external researchers. Unless otherwise stated, the authors are not affiliated with IBI, nor was the research executed on IBI’s behalf. IBI members are encouraged to obtain the original articles from the copyright holder.

What is the Issue?

Economic evaluations of occupational health and safety (OSH) initiatives typically take a societal perspective and include all related costs. Stakeholders such as employers have more limited interests; only costs that impact their enterprise are relevant. The quality of economic evaluations that focus below the societal level is not well known.

What are the findings/solutions?

The overall level of quality of original studies was poor. The authors caution that using results of poorly executed economic evaluations may lead companies to inappropriately allocate OSH resources. Better attention should be paid to the measurement and valuation of costs, sensitivity analyses, and reporting uncertainty around costs and cost-effectiveness estimates.

Journal Citation

Uegaki, K., de Bruijne, M. C., Lambeek, L., Anema, J. R., van der Beek, A. J., van Mechelen, W., & van Tulder, M. W. (2010). Economic evaluations of occupational health interventions from a corporate perspective–a systematic review of methodological quality. Scandinavian journal of work, environment & health, 273-288.

Objectives

To assess the methodological quality of economic evaluations of OSH interventions. By quality it is meant methodological rigor and the relative absence of bias, which limits the usefulness of conclusions and recommendations on which top corporate managers may base decisions to fund OSH programs and services. Previous reviews have found economic evaluations to be of low quality, but these were narrowly focused on the location of treatment or on treatment of particular conditions and suffered from a lack of standardized criteria for assessing quality.

Method

A systematic review of 34 peer-reviewed economic evaluations of OSH interventions. Included studies met seven criteria:

1. Study population was working age
2. Intervention was workplace or primary care service targeted at workers
3. Intervention was compared to an alternative, rather than no treatment
4. Outcome was an individual worker’s health-related productive capacity valued in monetary terms
5. Costs of intervention were included
6. Economic evaluation conducted from a corporate perspective
7. Study published in English or Dutch

Interventions were those intended to decrease the risk of health problems, identify at-risk employees, or limit the consequences of diagnosed health problems. Economic evaluations included cost-effectiveness (CE), cost-utility (CU), cost benefit (CB), and financial appraisal (FA) studies. Half the reviewed studies focused on musculoskeletal disorders. Studies were conducted in the US and internationally and represented a diversity of industries. The quality of the evaluations was assessed using a checklist of 19 methodological criteria regarding study design, conduct, analysis and generalizability of findings.

Results

The overall level of quality of original studies was poor. Only 15 of the 34 studies met more than half of the quality criteria. Only three studies met more than three-quarters of the criteria. The least-fulfilled criteria were:

• Declarations of potential conflicts of interest
• Discussions of ethical issues
• Costs measured in proper units
• Costs valued appropriately
• Well-defined, answerable research question posed
• Outcomes measured appropriately
  More recent studies tend to be of higher quality than earlier efforts.

Conclusion

The authors caution that using results of poorly executed economic evaluations may lead companies to inappropriately allocate OSH resources. Better attention should be paid to the measurement and valuation of costs, sensitivity analyses, and reporting uncertainty around costs and cost-effectiveness estimates. The checklist questions serve as a resource for improving the quality of research and for raising corporate decisions-makers’ awareness of potential methodological shortcomings in economic evaluations.