Department of Health Statistics, School of Public Health, Jinzhou Medical University, No. 40 Songpo Road, Jinzhou, Liaoning, 121000, People's Republic of China.
BMC Health Serv Res. 2022 Feb 28;22(1):266. doi: 10.1186/s12913-022-07654-7.
Coal workers' pneumoconiosis (CWP) remains one of the most severe occupational diseases in China. Despite the implementation of CWP comprehensive preventive measures, the unreasonable allocation of investment by coal enterprises limits the effect of preventing CWP, especially when the health resources are inadequate. This study aims to evaluate the cost-effectiveness of comprehensive measures for CWP from the perspective of coal enterprises.
Comprehensive measures and two primary interventions (engineering controls and individual protective equipment) were selected. A time-dependent Markov model was developed to evaluate cost and quality-adjusted life-years (QALYs). The input data were collected from the survey and literature. A hypothetical null situation, in which the currently implemented interventions were eliminated, was used as a comparator based on the generalised cost-effectiveness analysis (GCEA) recommended by the World Health Organization (WHO). The primary outcomes of the model were reported in terms of incremental cost-effectiveness ratios (ICERs). Uncertainty was verified using one-way and probabilistic sensitivity analyses.
The QALYs of the comprehensive measures, engineering controls, and individual protective equipment were 17.60, 17.50, and 16.85 years, respectively. Compared with null, the ICERs of the interventions were 65,044.73, 30,865.15, and 86,952.41 RMB/QALY, respectively. Individual protective equipment was dominated by an ICER of -11,416.02 RMB/QALY compared to engineering controls. Sensitivity analysis suggested the robustness of the results.
The comprehensive preventive measures for CWP that are currently implemented in Chinese state-owned mines are cost-effective. In comprehensive measures, engineering controls are more cost-effective than individual protective equipment. Investment in engineering controls should be increased to improve the cost-effectiveness of preventing CWP.
尘肺病是中国最严重的职业病之一。尽管实施了尘肺病综合防治措施，但煤炭企业投资配置不合理，限制了尘肺病的防治效果，尤其是在卫生资源不足的情况下。本研究旨在从煤炭企业的角度评价尘肺病综合防治措施的成本效益。
选择综合措施和两种主要干预措施（工程控制和个体防护装备）。采用时变马尔可夫模型来评估成本和质量调整生命年（QALYs）。输入数据来自调查和文献。根据世界卫生组织（WHO）推荐的广义成本效益分析（GCEA），将目前实施的干预措施全部消除的一般情况作为对照。模型的主要结果以增量成本效益比（ICERs）报告。采用单因素和概率敏感性分析验证不确定性。
综合措施、工程控制和个体防护装备的 QALYs 分别为 17.60、17.50 和 16.85 年。与对照相比，干预措施的 ICERs 分别为 65044.73、30865.15 和 86952.41 人民币/QALY。与工程控制相比，个体防护装备的 ICER 为-11416.02 人民币/QALY，处于劣势地位。敏感性分析表明结果具有稳健性。
中国国有煤矿目前实施的尘肺病综合防治措施具有成本效益。在综合措施中，工程控制比个体防护装备更具成本效益。应增加工程控制投资，以提高尘肺病防治的成本效益。
