Cost burden of latex allergy in healthcare systems

Latex allergy was a topic that appeared on the Bandolier Internet site several years ago, and one that has attracted substantial attention since we first reviewed it (bandopubs/NHSSlatex.html). The prevalence of latex allergy depends to a large extent on how the allergy is determined because different tests give different results. They all have the same general magnitude, of 8% to 17%.

Latex has become a bigger issue because better working practices intended to reduce infections, especially hepatitis and HIV, mean that gloves are used more widely than ever. But latex is a major constituent of many products (see here). The result of new tests for latex allergy together with its wider use is a greater recognition that latex allergy imposes a burden on healthcare systems.

That burden is either the use of non-latex, and more expensive, products like latex-free gloves, or disability or illness in its labour force. Either way there is a cost. Putting the human cost aside, the question that remains is on what side of the equation is the larger of the costs? Buying latex free products or the disability of workers? A new study helps decide [1].

Study

The study compared two strategies, a latex-safe strategy versus the status quo, in three healthcare institutions in Georgia USA. These were a tertiary care hospital, a community hospital, and an outpatient internal medicine clinic. Information on costs and purchasing patterns of gloves was obtained from the purchasing departments of each organisation. The number of workers, and the proportion exposed to latex was also obtained. The percentage at risk of disability was determined from the lowest literature figure.

Because latex-free gloves cost more than latex gloves, the cost analysis set out to determine the percentage of at-risk personnel who would have to become fully or partially disabled to offset the costs saved by not buying latex-free gloves.

Results

The key results are shown in the Table for each of the three institutions. The number of at-risk people with latex allergy (8%) and asthma (2.5%) were assumed from epidemiological data. The annual glove costs for latex gloves and latex-safe gloves were calculated for each institution over one year. There were significant increased costs for latex-safe gloves.

The cost of a worker who had total disability was calculated as $109,000 in an insured scenario in which workers who qualify for total disability receive wage replacements equal to two-thirds of their average weekly wage ($300 maximum) for 400 weeks. The additional cost of the latex-safe gloves would have been offset by 1.1% of workers in the tertiary hospital, by 0.45% of workers in the community hospital, and by 0.02% of workers in the outpatient clinic.

The cost of a worker who had partial disability was calculated as $62,000 in an insured scenario in which workers who qualify for permanent partial disability receive wage replacements equal to two-thirds of their average weekly wage ($300 maximum) for 350 weeks. The additional cost of the latex-safe gloves would have been offset by 1.9% of workers in the tertiary hospital, by 0.8% of workers in the community hospital, and by 0.04% of workers in the outpatient clinic.

Table: Cost analysis of latex allergy in three institutions in Georgia

  Tertiary care hospital Community hospital Outpatient clinic
Feature
Number of beds/rooms 890 520 22
Total personnel 5800 2750 24
Exposed personnel 5520 2600 22
Number with latex allergy (8%) 442 208 2
Number with latex asthma (2.5%) 138 65 1
Annual glove costs latex ($) 932,000 498,000 1,676
Annual glove costs latex-safe ($) 1,448,000 615,000 1,724
Difference 516,000 117,000 48
Total disability scenario: Wage replacement & diagnostic costs per worker $109,000
Break-even number on total disability 4.700 1.100 0.004
Percentage of at-risk pool 1.1 0.45 0.02
Partial disability scenario: Wage replacement & diagnostic costs per worker $62,000
Break-even number on total disability 8.300 1.900 0.001
Percentage of at-risk pool 1.9 0.78 0.04

Comment

These results relate to Georgia, USA, which has very conservative worker compensation benefits. Countries, states, or institutions with more generous benefits packages would produce figures that were much more balanced towards the use of latex-safe gloves.

The importance of this article is that it demonstrates how any institution could approach the issue of latex allergy and its consequences for workers for itself. That might be a very sensible thing to do. The evidence about latex and its health consequences is substantial. Workers injured through latex contact when there are safe alternatives with a cost argument that is balanced might have a good case for significant damages for negligence against management. That would send the costs of not having a latex-safe policy even higher.

In any event, this article concluded that the overall economic benefits were in favour of a latex-safe policy.

Reference:

1 VL Phillips, MA Goodrich, TJ Sullivan. Health care worker disability due to latex allergy and asthma: a cost analysis. American Journal of Public Health 1999 89: 1024-1028.