title: Comparative cost-effectiveness of two interventions to promote work functioning by targeting mental health complaints among nurses: pragmatic cluster randomised trial.
abstract: BACKGROUND
  The specific job demands of working in a hospital may place nurses at elevated risk for developing distress, anxiety and depression. Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning.
  
  
  OBJECTIVE
  To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints. Three conditions were compared: the control condition consisted of online screening for mental health problems without feedback about the screening results. The occupational physician condition consisted of screening, feedback and referral to the occupational physician for screen-positive nurses. The third condition included screening, feedback, and referral to e-mental health.
  
  
  METHODS
  The study was designed as an economic evaluation alongside a pragmatic cluster randomised controlled trial with randomisation at hospital-ward level.
  
  
  METHODS
  The study included 617 nurses in one academic medical centre in the Netherlands.
  
  
  METHODS
  Treatment response was defined as an improvement on the Nurses Work Functioning Questionnaire of at least 40% between baseline and follow-up. Total per-participant costs encompassed intervention costs, direct medical and non-medical costs, and indirect costs stemming from lost productivity due to absenteeism and presenteeism. All costs were indexed for the year 2011.
  
  
  RESULTS
  At 6 months follow-up, significant improvement in work functioning occurred in 20%, 24% and 16% of the participating nurses in the control condition, the occupational physician condition and the e-mental health condition, respectively. In these conditions the total average annualised costs were €1752, €1266 and €1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of €5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health condition versus the control condition was estimated at €4054 (added costs) per treatment responder. Sensitivity analyses attested to the robustness of these findings.
  
  
  CONCLUSIONS
  The occupational physician condition resulted in greater treatment responses for less costs relative to the control condition and can therefore be recommended. The e-mental health condition produced less treatment response than the control condition and cannot be recommended as an intervention to improve work functioning among nurses.
authors.affiliation: Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands. Electronic address: c.noben@maastrichtuniversity.nl.
authors.forename: Cindy
authors.initials: C
authors.lastname: Noben
authors.affiliation: Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, EMGO+ Institute of Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.affiliation: Coronel Institute of Occupational and Environmental Health, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: Nieuwenhuijsen
authors.affiliation: Coronel Institute of Occupational and Environmental Health, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ketelaar
authors.affiliation: Coronel Institute of Occupational and Environmental Health, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Fania
authors.initials: F
authors.lastname: Gärtner
authors.affiliation: Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Boon
authors.affiliation: Coronel Institute of Occupational and Environmental Health, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Sluiter
authors.affiliation: Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
authors.forename: Silvia
authors.initials: S
authors.lastname: Evers
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology*; D008875:Middle Aged; D009740:Nursing Staff
keywords: Cost effectiveness; Mental disorders; Nurses; Occupational health; Prevention and control; Randomised controlled trial; Stress; Work functioning