What is the most cost-effective way to identify silica problem worksites?

Background State based surveillance systems to identify cases of silicosis have been developed over the past 18 years to target worksite interventions to reduce the incidence of silicosis. Using data from the Michigan silicosis surveillance system, we conducted an analysis to determine the most cost‐effective way to identify problem worksites. Methods The initial reporting source of all 470 confirmed cases of silicosis reported to the Michigan surveillance system from 1989 to 1995 was identified. The cost of identifying confirmed cases, worksites, problem worksites, silica problem worksites, and the number of current silica‐exposed workers was determined for four reporting sources: hospitals; physicians; workers' compensations; and death certificates. Results Hospital reports were the first to identify 67% of the confirmed cases, 74% of the worksites, and 58% of the problem worksites. Physician reports initially identified 17% of confirmed cases, 15% of worksites, and 26% of problem worksites. Workers' compensation records initially identified 11% of confirmed cases, 4% of worksites, and 8% of problem worksites. Death certificates initially identified 5% of confirmed cases, 7% of worksites, and 8% of problem worksites. Hospital reports were the most cost‐effective way to identify cases (US$ 143), worksites (US$ 313), and problem worksites (US$ 454). Conclusions Hospital discharge records identified the greatest number of confirmed cases and problem worksites and was the most cost‐effective approach to identify both individuals with silicosis and worksites with problems. Am. J. Ind. Med. 39:629–635, 2001. © 2001 Wiley‐Liss, Inc.