title: Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries.
abstract: BACKGROUND
  Return-to-work (RTW)-interventions support cancer survivors in resuming work, but come at additional healthcare costs. The objective of this study was to assess the budget impact of a RTW-intervention, consisting of counselling sessions with an occupational physician and an exercise-programme. The secondary objective was to explore how the costs of RTW-interventions and its financial revenues are allocated among the involved stakeholders in several EU-countries.
  
  
  METHODS
  The budget impact (BI) of a RTW-intervention versus usual care was analysed yearly for 2015-2020 from a Dutch societal- and from the perspective of a large cancer centre. The allocation of the expected costs and financial benefits for each of the stakeholders involved was compared between the Netherlands, Belgium, England, France, Germany, Italy, and Sweden.
  
  
  RESULTS
  The average intervention costs in this case were €1,519/patient. The BI for the Netherlands was €-14.7 m in 2015, rising to €-71.1 m in 2020, thus the intervention is cost-saving as the productivity benefits outweigh the intervention costs. For cancer centres the BI amounts to €293 k in 2015, increasing to €1.1 m in 2020. Across European countries, we observed differences regarding the extent to which stakeholders either invest or receive a share of the benefits from offering a RTW-intervention.
  
  
  CONCLUSIONS
  The RTW-intervention is cost-saving from a societal perspective. Yet, the total intervention costs are considerable and, in many European countries, mainly covered by care providers that are not sufficiently reimbursed.
authors.affiliation: Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands. j.c.mewes@utwente.nl.
authors.forename: Janne C
authors.initials: JC
authors.lastname: Mewes
authors.affiliation: Hutchinson Institute for Cancer Outcomes Research, University of Washington, 1110 Fairview Avenue North, 98109 WA, Seattle, USA. lsteuten@fredhutch.org.
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
authors.affiliation: Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333 AL, Leiden, The Netherlands. i.groeneveld@sophiarevalidatie.nl.|Sophia Rehabilitation, Vrederustlaan 180, 2543 SW, The Hague, The Netherlands. i.groeneveld@sophiarevalidatie.nl.
authors.forename: Iris F
authors.initials: IF
authors.lastname: Groeneveld
authors.affiliation: Coronel Institute of Occupational Health, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.g.deboer@amc.uva.nl.
authors.forename: Angela G E M
authors.initials: AG
authors.lastname: de Boer
authors.affiliation: Coronel Institute of Occupational Health, Amsterdam Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.frings@amc.uva.nl.
authors.forename: Monique H W
authors.initials: MH
authors.lastname: Frings-Dresen
authors.affiliation: Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands. m.j.ijzerman@utwente.nl.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
authors.affiliation: Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands. w.v.harten@nki.nl.|Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. w.v.harten@nki.nl.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D004526:Efficiency; D005060:Europe; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000534:rehabilitation; D009426:Netherlands; D012050:Rehabilitation, Vocational / Q000191:economics*; D062707:Return to Work / Q000191:economics*; D018582:Sick Leave; D017741:Survivors