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WHEN EMPLOYERS LOOK at the cost of various diseases that strike their employees, the impact on their medical plan costs is usually top of mind. For acute conditions, such as cancer and heart disease, the costs of medical treatment are considerable. However, other costs, such as lost work time, disability costs and in some cases death and employee replacement costs, are significant. Considering the total cost to employers of high-profile diseases, it is easy to understand why most employers and even some benefits professionals would not identify allergy as a disease with a significant impact on total benefit costs.
Benefit managers should consider these major costs of allergic rhinitis:
About 3.5 million lost workdays per year (more than 9% of all lost work days), at a cost of more than $500 million.
About 1.5 million lost schooldays, leading to additional parenting time that affects work performance and productivity.
Seven million to 8 million physician office visits annually for the treatment of allergies, at a cost of more than $400 million.
More than $2 billion annually spent on prescription and over-the-counter medications for allergies.
Inappropriate self-medication with sedating products has been directly linked to increased workers compensation costs due to workplace injuries as well as impaired work performance.
What employers can do
About one in five Americans suffers from allergic rhinitis, making the disease more common than back problems or high blood pressure. Given this high incidence, employers need to integrate an allergy education campaign in any wellness program they may offer. Employers also need to require health plans to educate employees about the disease and the most cost-effective treatments. Because self-treatment is so common, employees need to understand the advantages and disadvantages of the over-the-counter and prescription medications available. Of particular importance are the sedating effects of some medications, which can produce the impairment equivalent of a 0.05% blood alcohol level-legal intoxication in many states. Therefore, making employees and their dependents aware of allergy problems and providing education regarding individual risk assessment, treatment options and effective treatment options is critical.
The risk management area should carefully review the occupational safety impacts of allergies and their treatments and develop monitoring and educational programs. Dangerous side-effects of allergies and some medications to treat the disease include confusion, fatigue, drowsiness and depressed physical and mental function. Some jobs are particularly at risk, especially those requiring high levels of awareness and cognitive skills. The Federal Aviation Administration, for example, has banned pilots from using sedating antihistamines, a primary source of the dangerous side-effects discussed above.
Sick building syndrome, poor air quality and air filtration systems are important environmental risks to assess. Building air-quality monitoring programs may be warranted depending on the location and type of building.
What the condition is
Often called "hay fever," allergic rhinitis is the most common allergy disease. There are two principal types. Seasonal rhinitis, commonly known as hay fever, is the most prevalent. Seasonal rhinitis coincides with pollination, and symptoms climax during spring (tree pollen), late spring (grasses) and late summer or early fall (various weeds). Perennial rhinitis can occur at any time of the year depending upon exposure to various antigens, which are irritants to air passages and the respiratory system. The most common perennial antigens are dust mites, mold spores, dander, house dust and pollutants. For seasonal and perennial allergies, avoiding exposure to antigens is effective but often not possible, as most antigens are airborne and most ventilation systems are not capable of filtering out a substantial number of antigens. Fortunately, pharmacological interventions allow most symptoms to be managed to tolerable levels. However, some pharmacological interventions can have undesirable side-effects.
Allergies affect people in many ways and as a result affect their work performance. Individuals with allergies generally suffer from watery eyes, sneezing, nasal concentration, headaches and various other maladies. The severity and duration of these allergic reactions will vary based on an employee's age, family history, level of antigens, exposure and individual immune system response. The severity of the disease can be wide-ranging and individually specific, both in terms of the individual sensitivity to particular antigens and the number of antigens that create an allergic reaction.
The total cost of allergies in terms of lost workdays and impaired productivity is estimated to be more than $11 billion, or $1,000 per afflicted worker per year. This significant level of lost productivity is due to a number of factors. Lost workdays (and lost schooldays for dependents of workers) create significant amounts of time away from the job. In addition, surveys of allergy sufferers report nearly three workweeks annually of reduced performance while at work due to allergic rhinitis. This lessened productivity results from decreased mental alertness and impaired motor skills. These debilitating conditions can be caused by the disease symptoms as well as the side-effects of medications. Additionally, there are workers compensation claims for on-the-job injuries resulting from the dangerous side-effects of inappropriate medications.
Common pharmacological responses to these allergies include antihistamines, decongestants, anticholinergics, mast cell stabilizers and corticosteroids. However, some antihistamines-principally first generation antihistamines-can cause anxiety, confusion, fatigue, drowsiness, irritability and depress physical and mental function. Decongestants can cause palpitations and increased blood pressure. Anticholinergics infrequently cause palpitations and increased blood pressure, as well as nose dryness bloody mucus. These side-effects can have serious implications. In many states, it is illegal to drive a car while under the influence of certain antihistamines. Operators of heavy equipment, transportation workers and jobs requiring high levels of awareness and/or cognitive skills are particularly at risk to adverse side-effects.
Many employees underestimate or are unaware of the adverse impact on work performance of some medications. Additionally, the self-diagnosis and self-medication common with this disease can lead to dangerous drug interactions.
Pamela M. Hastie is a principal and benefits consultant and G. Todd Swim is a principal and health actuary, both at Buck Consultants Inc. in Chicago.