Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections.

BACKGROUND: There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS: We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008-09 and 2009-10 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS: The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490-$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS: The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.

Comparative Cost of Stockpiling Various Types of Respiratory Protective Devices to Protect the Health Care Workforce During an Influenza Pandemic.

Specific guidance on the size and composition of respiratory protective device (RPD) stockpiles for use during a pandemic is lacking. We explore the economic aspects of stockpiling various types and combinations of RPDs by adapting a pandemic model that estimates the impact of a severe pandemic on a defined population, the number of potential interactions between patients and health care personnel, and the potential number of health care personnel needed to fulfill those needs. Our model calculates the number of the different types of RPDs that should be stockpiled and the consequent cost of purchase and storage, prorating this cost over the shelf life of the inventory. Compared with disposable N95 or powered air-purifying respirators, we show that stockpiling reusable elastomeric half-face respirators is the least costly approach. Disposable N95 respirators take up significantly more storage space, which increases relative costs. Reusing or extending the usable period of disposable devices may diminish some of these costs. We conclude that stockpiling a combination of disposable N95 and reusable half-face RPDs is the best approach to preparedness for most health care organizations. We recommend against stockpiling powered air-purifying respirators as they are much more costly than alternative approaches.

Economic analysis of the use of facemasks during pandemic (H1N1) 2009.

A large-scale pandemic could cause severe health, social, and economic impacts. The recent 2009 H1N1 pandemic confirmed the need for mitigation strategies that are cost-effective and easy to implement. Typically, in the early stages of a pandemic, as seen with pandemic (H1N1) 2009, vaccines and antivirals may be limited or non-existent, resulting in the need for non-pharmaceutical strategies to reduce the spread of disease and the economic impact. We construct and analyze a mathematical model for a population comprised of three different age groups and assume that some individuals wear facemasks. We then quantify the impact facemasks could have had on the spread of pandemic (H1N1) 2009 and examine their cost effectiveness. Our analyses show that an unmitigated pandemic could result in losses of nearly $832 billion in the United States during the length of the pandemic. Based on present value of future earnings, hospital costs, and lost income estimates due to illness, this study estimates that the use of facemasks by 10%, 25%, and 50% of the population could reduce economic losses by $478 billion, $570 billion, and $573 billion, respectively. The results show that facemasks can significantly reduce the number of influenza cases as well as the economic losses due to a pandemic.

Dust control technology usage patterns in the drywall finishing industry.

A telephone survey was conducted to quantify drywall finishing industry usage rates of dust control technology, identify barriers to technology adoption, and explore firm owner perception of risk. Industry use of the following technologies was described: wet methods, respiratory protection, pole sanders, ventilated sanders, and low-dust joint compound. A survey instrument composed of both Likert-type scaled items and open-ended items was developed and administered by telephone to the census population of the owners of member firms of trade associations: Finishing Contractors Association and Association of the Wall and Ceiling Industries. Of 857 firms, 264 interviews were completed. Along with descriptive statistics, results were analyzed to examine effects of firm size and union affiliation on responses. Responses to open-ended items were analyzed using content analysis procedures. Firm owners rated the risk of dust to productivity and customer satisfaction as low-moderate. Half rated the dust as having some impact on worker health, with higher impacts indicated by owners of small firms. Among the available control technologies, respiratory protection was used most frequently. Several barriers to implementation of the more effective control technologies were identified. Barriers associated with technology usability, productivity, and cost, as well as misperceptions of risk, should be addressed to improve dust control in the drywall finishing industry.

Enjoying the advantages of PAPRs.

For those who are hard to fit with a respirator, for those with facial hair, and to improve your employees' comfort and increase productivity, a PAPR may be just the respirator for your program. Do your homework, start with a small test group, and you may find that PAPRs deliver.

The costs of healthcare worker respiratory protection and fit-testing programs.

OBJECTIVE: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB). DESIGN: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study. SETTING: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB. RESULTS: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526). CONCLUSIONS: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.

Activity-based cost management. Part II: Applied to a respiratory protection program.

To demonstrate the relevance of activity-based cost management (ABCM) for the occupational and environmental health community, the investigators used data generated by an ABCM model of a respiratory protection program (RPP) to develop options for solving a business problem. The RPP manager in this hypothetical but realistic business scenario is faced with a 25% budget cut and a 10% increase in demand for RPP services. The manager's dilemma is to maintain the integrity of the RPP while absorbing a significant budget cut. Various cost savings options are developed, and the assumptions under which these options operate are presented. It is emphasized that the RPP manager's primary responsibility is to assure worker health and safety by first understanding the technical issues, merits, and implications of any cost-cutting option that may be considered. It is argued that only then should the manager consider the financial merits of the possible solutions to this business problem. In this way worker health and safety, and environmental protection goals, can continue to be achieved in an economic climate of cost cutting and downsizing.

The cost-effectiveness of preventing tuberculosis in physicians using tuberculin skin testing or a hypothetical vaccine.

BACKGROUND: Tuberculin skin testing using the purified protein derivative is recommended as part of a tuberculosis control program for health care workers. However, compliance with skin testing programs has been poor and their cost-effectiveness is unknown. METHODS: A Markov-based decision analysis was performed to determine the cost-effectiveness of tuberculin skin testing over the entire lifetimes of physicians who are now in medical school. Assumptions were deliberately chosen to present a conservative estimate of cost-effectiveness. Indirect costs were not included. RESULTS: Annual testing cost $29,000 per life-year saved and $39,000 per case of pulmonary tuberculosis prevented. In contrast, particulate respirators have been shown to cost millions of dollars per case prevented. Skin testing every 6 months was cost-effective in a subpopulation at high risk of infection (> or = 1.8-fold). During their entire lifetimes, physicians now in medical school can expect to avert 137 cases of pulmonary tuberculosis, prevent 7 tuberculosis deaths, and save 182 life-years because of skin testing programs. Improved compliance with annual skin testing and prophylactic isoniazid could more than triple this benefit. If available, a moderately effective vaccine would be even more cost-effective than tuberculin skin testing programs. CONCLUSIONS: Tuberculin skin testing is cost-effective and should be an integral part of any tuberculosis control program. Vaccination may one day be a feasible and cost-effective alternative to skin testing programs.

Does a cheaper mask save money? The cost of implementing a respiratory personal protective equipment program.

OBJECTIVE: To determine the annual cost of implementing and maintaining a respiratory personal protective equipment (PPE) program at an urban hospital. SETTING: St Clare's Hospital and Health Center, a 250-bed hospital in Manhattan that treats 60 to 100 cases of tuberculosis annually. METHODS: Review of Purchasing Department records for all masks acquired by the hospital from 1992 to 1995, and an estimate of administrative time spent developing and implementing the guidelines recommended by various agencies during the study interval. RESULTS: Respiratory isolation was provided for 6,360 to 10,883 days annually during the 4-year interval. Yearly costs for the PPE program ranged from $86,560 to $175,690. Of note, the daily cost for a respiratory isolation day decreased dramatically between 1994 and 1995 ($25/day to $13/day), when the high-efficiency particulate air-filter (HEPA) respirator was used by all staff. The decrease occurred because of lower administrative costs and a sharp decrease in the numbers of HEPA units purchased. Objective measures of worker compliance with HEPA respirators demonstrated the decrease was not due to less HEPA use but rather that employees were using each HEPA unit for several weeks, as recommended. CONCLUSION: We found a significant decrease in cost in the second year of our HEPA program due to increasing employee familiarity with the program. Newly approved, cheaper, but less durable, N-95 masks are unlikely to withstand multiple wearings and may be discarded after a few uses. Thus, cheaper masks may result in a more expensive PPE program.

Industry anticipates big savings with new masks.

AIDS: A variety of new, lowcost mask respirators will replace high-efficiency particulate air (HEPA) respirators currently used by hospitals in the control and prevention of tuberculosis (TB). Previously, the U.S. Occupational Safety and Health Administration (OSHA) has required HEPA masks since they were the only product that met protective standards. The National Institute of Occupational Safety and Health (NIOSH) tested new respirators and will certify nine types of respirators in three overall classes. The first thirteen respirators would cost less than $1 to $3. A health care worker may reuse the same disposable respirator as long as the equipment maintains its structural and functional integrity. Health care employers remain responsible for establishing and maintaining respirator protection programs. The use of respirators for protection against occupational TB exposure will be reconsidered during the OSHA rule-making process for the TB standard.^ieng