Economic Impact of the
Wellness Fitness Initiative
Kerry Kuehl MD DrPH
Department of Medicine
Oregon Health & Science University
Cost of Injury and Illness

In the U.S., total direct and indirect costs
associated with work-related injuries and
illnesses are > $150 billion or nearly 3 percent of
the gross domestic product (Leigh et al., 2000).
 Injuries are responsible for the majority of those
events, with illness accounting for only 15%.
 These costs are three times that of Alzheimer’s
disease and nearly equivalent to the costs for
cancer.
High Risk Combination
Fire fighters have
health risks similar to
the average American
and their work is more
physically demanding
This combination
places FF at high risk
for heart disease
Leading cause of death
fighting fires is heart
disease
Risks are similar to other Americans
65% > 3 cardiac risk factors
40% > 4 cardiac risk factors
30%
25%
20%
Sedentary lifestyle
High fat diet
Obesity
Dyslipidemia
Diabetes
High blood pressure
15%
10%
5%
0%
0
1
2
3
4
5
6
7
Number of Risk Factors (Combined Data)
Background
 The
overall economic impact of workrelated injuries and illness is high.
 Firefighters are an especially high-risk
group for musculoskeletal injuries and
other work-related health problems.
 New means to reduce work-related
illness and injury are needed.
8.6X more injuries among FF than private industry
Most Hazardous Occupation
 The
fire service is one of the most hazardous
occupations. The incidence of work-related
injury is eight times that of private industries.
 NFPA estimated > 80,000 firefighter injuries
occurred in the line of duty in 2005.
 This was an increase of 5.6%, and the
highest rate since 2002 (Karter & Molis,
2006).
Incidence of FF Injuries

Each year, approximately one-third of the more
than one million U.S. firefighters sustain a work
related injury.
 National Institute of Standards and Technology
(NIST) released a study that estimated the 2002
costs of injuries and efforts to prevent them was
from $2.8 billion to $7.8 billion per year (TriData
Corporation, 2005).
Balance Sheet: $$ OUT
WFI:Screening
 Costs of Testing
treadmill stress test
physical exam
laboratory tests
body weight/% fat
mental health
strength
flexibility
pulmonary functions
dietary history
 Costs of Follow up
(evaluation abnormal results,
injuries during testing)
Many benefits are
long-term and won’t
show up on a short
term economic
analysis.
 Costs for a Program
Balance Sheet: $$ SAVED
Comprehensive Medical
Lipids
Bloodwork
BP
Aerobic Fitness
Lung Function
Strength
Flexibility
Body Comp
Questionnaire
Testing Only
$600
$500$1000
Dollar Costs per Firefighter
for Testing Only
$500
$400
$300
$200
$100
treadmill stress test
physical exam
laboratory tests
strength
$250
flexibility
pulmonary functions
body weight/% fat
dietary history
$100
$0
Full Meal Deal Minus Stress Test Labs & Surveys
What Level of Testing Is
Cost Effective?






Cost to diagnose 1 case of hepatitis: $10,000.
Cost to diagnose 1 FF with CHD = $100,000.
Hepatitis: Quality-Adjusted Life Year (QALY) =
$10,000 per QALY for Blood Test.
CHD: $100,000 per QALY for Stress Testing.
Standard Index for a Cost-Effective Procedure is
< $50,000 per QALY.
Not Cost-Effective to Stress Test all FF.
Follow-up Costs For Abnormal
Blood Test – Liver Enzymes
Test
Number
Cost
Total Cost
Chem-20:
600
30
$11
$75
$6600
$2250
5
$250
$1250
Follow-up
Lab
Hepatitis
Panel
To identify 1 case of asymptomatic hepatitis: Total = $ 10,000
Follow-up Costs For
Abnormal Stress Tests
TEST
NUMBER
COST
TOTAL $$
Stress Test
600
$250
$150,000
Thallium/Echo
70
$1000
$70,000
Cardiologist
10
$250
$2500
Cardiac Cath
10
$2500
(3 Severe CAD)
$25,000
Bypass Surgery
2
$25,000
$50,000
Coronary A Stent
1
$7,500
$7500
To identify 3 FF who have severe CAD:
Total = $305,000
Considerations of Test
Selection
 Additional
follow-up costs must be
considered when selecting test
 In addition to picking the package,
consider the risk profile of those being
tested
 Risk Stratification to identify those at high
risk is cost effective (i.e., not cost effective
to stress test all FF annually)
Balance Sheet: IN
Short Term and Long Term Benefits Of A
Wellness Program
WHAT IS THE BOTTOM LINE?
Preventing Injury
Reducing Costs
Decreasing Morbidity and Mortality
Business Case For Worksite
Wellness
 Majority
of studies show positive ROI ~ $3
 Negative studies not published
 Threats to validity (self selection, low
participation, high dropout, effects difficult
to measure)
 Savings about $250/employee at 4 years
 What about the fire service?
Economics of Fire Fighter
Wellness
 Clearly,
in other industries, research
supports the cost-effectiveness of worksite
wellness
 Wellness programs among fire fighters
less obvious
 One of major roadblocks in preventing fire
departments from implementing WFI is
concerns about return on investment (ROI)
COST OF MAINTENANCE &
REPAIR (Percent of Budget)
Fire
Apparatus
Firefighter
Maintenance
70%
3%
Repair
30%
97%
TOTAL
100%
100%
Is FF Wellness Cost-Effective?

Phoenix: 6 years after implementing wellness
program, severity of injuries decreased by 46%.
 Wichita: 50% reduction in sick leave after
implementing fitness program.
 South Pasadena: Injury rates reduced over 50%
after wellness program introduced.
 PHLAME program in Oregon (retrospective)
35
Injury Rates
30
25
Figure 4: Slope of change (with SEM) for injury rates between PHLAME and Non-PHLAME Fire Bureaus in Oregon as reported in
Table 2. Statistical significance is at the p<.0001 level.
*
rates among PHLAME and Non-PHLAMEPHLAME
fire bureaus
20Injury
*
*
15
*
Non-PHLAME
* P < .0001
10
5
0
1999
2000
2001
2002
PHLAME Study Year
2003
FD Savings From Reduced
Injuries As Compared to 1999
Cost Savings/FF
Total (687 FF)
2001
2002
$1353
$1600
$929,511
$1,100,200
IAFF Awards OHSU Grant To
Review Economic Impact of
Wellness Fitness Initiative

In 2006-2007, the original 10 cities WFI task
force fire departments contacted
 Site visits with HR and RM to review data
availability diversity, and complexity
 8 departments collected long term data with
accessible computer data base
 Retrospective study and data analysis
Fire
Department
Personnel WFI Participation WFI Participation
Rate in 1997
Rate in 2004
Austin
1032
CONTROL
CONTROL
Calgary
983
CONTROL
CONTROL
Fairfax Co
1280
65%
85%
Indianapolis 780
70%
95%
LA County
10%
55%
Miami-Dade 1900
CONTROL
CONTROL
Phoenix
1588
70%
90%
Seattle
1015
CONTROL
CONTROL
3013
Outcome Data
 Data
represents aggregate or average of 4
WFI and 4 Non-WFI fire departments with
no ability to identify individual FD claims
 Occupational Injury/Illness Claims
 Total Incurred Costs
 Number of Lost Work Days (LWD)
 Average Cost Per Claim
RESULTS
 The
mean total claims, lost work days, and
total incurred costs represent service or
occupational benefits paid per fiscal year
for a department.
 Data from these fire departments do not
include any non-occupational claims and
costs due to difficulty with tracking this
information through private insurance and
individual medical providers.
Occupational Claims Between
WFI and Non-WFI Departments
Claim Date
WFI Claims
Non-WFI Claims
1991-1997 Totals
3,033
2,459
1998-2004 Totals
3,210
3,023
Percent Change
5% Increase 22% Increase*
*Statistically significant at p<.05
Total Incurred Cost* Between
WFI and Non-WFI Departments
Claim Date
WFI Costs
Non-WFI Costs
1991-1997 Totals $21,695,644
$17,055,723
1998-2004 Totals $22,276,143
$26,991,766
Percent Change
3% Increase
58% Increase
*Health care costs increased 7% annually past decade
Lost Work Days* Between WFI
and Non-WFI Departments
Claim Date
WFI Lost
Work Days
Non-WFI Lost
Work Days
1991-1997 Totals 40,611
26,747
1998-2004 Totals 31,671
41,388
Percent Change
28%Decrease 55% Increase
*Some departments had lost hours or did not have lost time calculated
Average Cost Per Claim Between
WFI and Non-WFI Departments*
Claim Date
WFI Average
Cost / Claim
Non-WFI Average
Cost / Claim
1991-1997 Totals $56,845
$47,912
1998-2004 Totals $46,225
$64,608
Percent Change
-23%
Decrease
35% Increase
*Calculated from Total Incurred Cost divided by Number of Claims
60%
58%
55%
50%
35%
40%
30%
22%
20%
3%
10% 5%
0%
-10%
-28%
-23%
-20%
-30%
Claims LWD Total Avg
Cost Cost
per
W.F.I
Non
W.F.I
DISCUSSION - COSTS
 Total
incurred costs increased $82,900 per
year per WFI department and increased
$1,419,435 per Non-WFI fire department
per year (adjusted to 2001 dollar
amounts).
 A difference
of $1,336,535 per year was
saved per WFI fire department as
compared to Non-WFI department.
CONCLUSION
 The
information presented suggests there
is an immediate reduction of occupational
injury/illness claims and costs among fire
departments that implemented the
IAFF/IAFC Wellness Fitness Initiative as
compared to fire departments that did not
implement the WFI.
CONCLUSION

The results also demonstrate that the WFI fire
departments have a lower rate of increasing
claims and costs while decreasing lost work
days and average cost per claim.
 The fact that lost work days and average cost
per claim are reduced suggests that
injury/illness severity is reduced, especially in
the face of rising healthcare costs greater than
the rate of inflation.
CONCLUSION
 Adoption
of the WFI confers a savings in the
short term.
 Long-term
economic benefit will be greater by
addition of a health promotion program through
prevention and early treatment of fire fighter
musculoskeletal injuries, cancer, and
cardiovascular disease
LIMITATIONS
Limitations of this study:
 Retrospective
 Data in various sizes, shapes, missing data
 Dosage effect and participation rate varied
 Further research with prospective study needed
to answer this question of economic benefit of
fire fighter wellness.
FUTURE DIRECTIONS

We have submitted a grant to CDC and NIH in
cooperation with the IAFF of a health
promotion/injury-reduction program for
firefighters utilizing PFT’s with WFI.
 The proposal builds on prior NIH-funded
behavior change research with firefighters
including a cost-effective analysis
PROSPECTIVE STUDY
In addition to workman’s compensation and
absenteeism claims, we also will track
intervention costs, which might be referred to as
opportunity costs, or the costs that would be
avoided by forging the intervention.
 Those include direct cost of the program, salary
of labor inputs (interventionists, scheduling
personnel), program materials, and
management inputs.
 Addition of PHLAME Behavioral component

THANK YOU!