Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain.
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.


METHODS
Economic evaluation alongside a randomised controlled trial (RCT).


METHODS
Workers sick-listed for a period of 2 to 6 weeks due to LBP.


METHODS
1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician.


RESULTS
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 euro). 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.


CONCLUSIONS
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.
Steenstra
Ivan A
IA
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Anema
Johannes R
JR
van Tulder
Maurits W
MW
Bongers
Paulien M
PM
de Vet
Henrica C W
HC
van Mechelen
Willem
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006804:Ergonomics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009784:Occupational Diseases / Q000191:economics / Q000534:rehabilitation*; D009785:Occupational Health Nursing; D009788:Occupational Therapy / Q000191:economics* / Q000379:methods; D012050:Rehabilitation, Vocational / Q000191:economics* / Q000379:methods