title: Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis.
abstract: OBJECTIVE
  Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity.
  
  
  METHODS
  Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings.
  
  
  RESULTS
  At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings.
  
  
  CONCLUSIONS
  The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.
authors.affiliation: Maastricht University, Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Health Services Research.
authors.forename: Cindy
authors.initials: C
authors.lastname: Noben
authors.affiliation: VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health.
authors.forename: Myrthe van
authors.initials: MV
authors.lastname: Vilsteren
authors.affiliation: VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health.
authors.forename: Cécile
authors.initials: C
authors.lastname: Boot
authors.affiliation: TNO Work, Health and Care.
authors.forename: Romy
authors.initials: R
authors.lastname: Steenbeek
authors.affiliation: Jan van Breemen Research Institute.|Academic Medical Centre, Department of Clinical Immunology and Rheumatology.
authors.forename: Dirkjan van
authors.initials: DV
authors.lastname: Schaardenburg
authors.affiliation: VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
authors.affiliation: Maastricht University, Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Health Services Research.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction.
authors.forename: Silvia
authors.initials: S
authors.lastname: Evers
authors.affiliation: Maastricht University, Faculty of Psychology and Neuroscience, Department of Work and Social Psychology.
authors.forename: Frans
authors.initials: F
authors.lastname: Nijhuis
authors.affiliation: Maastricht University, Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of Social Medicine.
authors.forename: Angelique de
authors.initials: A
authors.lastname: Rijk
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004526:Efficiency; D017598:Efficiency, Organizational / Q000191:economics*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016272:Occupational Health / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cost effectiveness; Integrated care; Occupational Health; Participatory workplace intervention; Productivity; Rheumatoid arthritis