Tightrope walking : external impact factors on workplace health management in small-scale enterprises

Small-scale enterprises (SSEs) are important for ensuring growth, innovation, job creation,and social integration in working life. Research shows that SSEs pay little attention to andhave insufficient competence in workplace health management. From the perspective ofmanagers, this study explores how external factors influence the development of thismanagement. The article refers to a case study among eight Norwegian and ten Swedishmanagers of SSEs in the middle part of Norway and Sweden. We used a stepwisequalitative approach to analyse data, using an interpretive indexing of main categories.Two main categories were found to have an influence on the development of workplacehealth management: (1) restricted leeway and (2) commitments. Concerning the first maincategory, areas that managers highlight as important comprise the legal framework andregulations; workforce and market situation, production, economy; and occupationalsafety and health issues. Areas related to the second main category were advice fromthe board, guidance from mentors, work-related networks, and family and friends asbuffers. One conclusion is that despite limited scope for developing workplace healthmanagement, managers find supportive guidance and inspiration from environments thatare committed to helping them and their enterprise

Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe &- the HEALTH model

Objective: To investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials. Methods: The HEALTH model (Health Economic Assessment of Life with Teveten® for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study ("Morbidity and Mortality after Stroke - Eprosartan Compared to Nitrendipine for Secondary Prevention"). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives. Results: Comparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (24,036) followed by Belgium (17,863), the UK (16,364), Norway ( 13,834), Sweden ( 11,691) and Spain ( 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (9136) followed by the UK (6008), Norway (1695), Sweden (907), Spain (-2054) and Belgium (-5767). Conclusions: Considering a 30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients 50 years old and a systolic blood pressure 160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients). © 2009, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)