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Screening for occupational disease among workers in a high-risk trade: examination of cost, yield, and potential for increased efficiency.

We evaluated the cost and yield of a general health surveillance program emphasizing the identification of occupationally related diseases among workers in a high-risk trade. Of approximately 4,000 eligible members of two local plumbers and pipefitters unions, 639 were screened in this program. Screening tests indicated either by specific occupational exposures (eg, chest X-ray, spirometry, and audiometry) or general clinical risk factors (urine analysis for those with a positive urine dipstick, and stool heme occult testing for those over 45 years of age) proved to be far less costly for each positive finding than those procedures (physical examination, complete blood count, and blood chemistry panel) that were not specifically indicated. A discriminant analysis revealed predictor variables (age, years in the trade, and presence of respiratory symptoms) that, in subsequent screening efforts, could be used in the unscreened population either to identify individuals who are more likely to have any positive test result or to "tailor" the content of the initial screening program for a single individual. Increasing the yield and decreasing the direct costs of screening activities may make programs like these more affordable. In addition, this program assisted workers in filing for compensation and thus served to promote the appropriate transfer of cost for the identification and management of occupational diseases from traditional forms of payment to workers' compensation insurance programs.