Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain |
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Authors: | Ivan A Steenstra Johannes R Anema Maurits W van Tulder Paulien M Bongers Henrica C W de Vet Willem van Mechelen |
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Institution: | (1) Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands;(2) Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands;(3) TNO Work and Employment, P.O. Box 718, 2130 AS Hoofddorp, The Netherlands;(4) Body@Work, Research Center Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands;(5) Institute for Health Sciences, VU University, Amsterdam, The Netherlands;(6) Institute for Work and Health, Toronto, ON, Canada |
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Abstract: | Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= −74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=−89.4, −2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.This study is granted by: The Netherlands Organisation for Health Research and Development (ZonMw), Dutch Ministries of Health, Welfare and Sports and, of Social Affairs. international Standard Randomised Controlled Trial Number: 60233560. |
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Keywords: | Low back pain Operant behavioural Participative Ergonomics Return to work Randomized Controlled Trial Cost-effectiveness Occupational health |
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