An occupational health intervention programme for workers at high risk for sickness absence. Cost effectiveness analysis based on a randomised controlled trial

Abstract

Objectives:To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence.Methods:Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed.Results:After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost €974 and €1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant—both cost saving and more effective than usual occupational health care. The saving was €43 per sickness absence day avoided with available direct total cost data, and €17 with missing total cost data imputed.Conclusions:One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.

Cross-National Validation of Prognostic Models Predicting Sickness Absence and the Added Value of Work Environment Variables

“…Alternatively, when researchers want to select high-risk individuals (e.g., for randomised-controlled trials or interventions) then cut-off risks [40 % should be chosen. In this regard, it is important to notice that Taimela et al [33] found that preventive consultations aimed at reducing SA were cost-effective only in high-risk workers, not in those at moderate or low risk of SA.…”

Screening manual and office workers for risk of long-term sickness absence: cut-off points for the Work Ability Index

“…Furthermore, interventions may alter the prognosis and consequences of LTSA. Taimela et al (14) showed that preventive consultations reduced sickness absence, although such consultations were cost-effective only among high-risk workers (15). The cost-effectivity of preventive consultations may increase when only high-risk workers are referred, which accentuates the need to screen for risk of LTSA.…”

Transferring results of occupational safety and health cost-effectiveness studies from one country to another – a case study

“…We would however have to go back to the individual patient data to be able to take this into account. ICER are difficult to interpret especially when the intervention saves more cost and is more effective than the alternative as in the case of Taimela et al (7) and as discussed by Drummond (4). The problem is that the highest combination of cost saving and effect gain does not necessarily translate into the best ICER.…”

“…Taimela et al (7) evaluated an occupational health intervention program for workers at high risk for sickness absence. A health risk appraisal questionnaire, sent to 3115 employees of a Finnish company, identified 418 employees at high risk for sickness absence who were willing to participate in the study.…”

“…This indicates a better result because more money was saved and more days of sickness absence avoided. For this article, we used the figures for the subgroup for which all costs figures could be derived from the questionnaire and as reported by Taimela et al (7).…”