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Progression from beryllium exposure to chronic beryllium disease: an analytic model
Philip Harber1, Siddharth Bansal, John Balmes
1Division of Occupational and Environmental Medicine, Department of Family Medicine, University of California at Los Angeles, Los Angeles, California 90024, USA. pharber@mednet.ucla.edu
Environmental Health Perspectives
|July 11, 2009
Summary
Understanding chronic beryllium disease (CBD) progression from beryllium exposure (BeE) is key. Modeling shows declining risk over time, suggesting optimized screening strategies for early intervention and resource allocation.
Area of Science:
- Occupational Medicine
- Pulmonary Medicine
- Epidemiology
Background:
- Beryllium exposure (BeE) can lead to chronic beryllium disease (CBD).
- Early detection and intervention are crucial for preventing CBD progression.
- Understanding the BeE to CBD timeline is essential for effective screening.
Purpose of the Study:
- To model the progression from beryllium exposure to chronic beryllium disease.
- To assess the cost-effectiveness of screening strategies for CBD.
- To identify optimal screening intervals and target populations.
Main Methods:
- Developed an analytic Markov model to simulate progression through BeE, beryllium sensitization, and CBD states.
- Utilized empirical data on prevalence and incidence to validate model parameters.
- Estimated the cost-effectiveness of screening, considering incremental and cumulative costs.
Main Results:
- A simple model with constant progression risk does not fit empirical data.
- Progression risk is highest initially and declines over time, suggesting at least two risk populations.
- Screening cost-effectiveness decreases over time but remains valuable for previously unscreened individuals with long latencies.
Conclusions:
- Screening intensity should decrease over time to optimize resource use.
- Lifetime cumulative CBD risk estimation must account for declining progression risk.
- Targeted screening of high-risk, previously unscreened individuals is cost-effective.
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