title: Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders.
abstract: OBJECTIVE
  Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR.
  
  
  METHODS
  A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4-8 months of disability, N = 373), intermediate duration (ID: 9-18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness.
  
  
  RESULTS
  At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88%), work retention (overall 80%), and additional healthcare utilization (overall, 2.2% of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64% in medical costs, and up to 80% in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56% lower when administered early. Overall, ER resulted in estimated cost savings of up to 72% (or almost $170,000 per claim).
  
  
  CONCLUSIONS
  Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of "last resort".
authors.affiliation: PRIDE Research Foundation, Dallas, TX, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Theodore
authors.forename: Tom G
authors.initials: TG
authors.lastname: Mayer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation; D009784:Occupational Diseases / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation*; D011446:Prospective Studies; D020127:Recovery of Function; D062707:Return to Work / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States