Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study

Abstract

Aims: To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention. Methods: A randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care. Results: At the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm. Conclusions: A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers' compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

Substantial sick-leave costs savings due to a graded activity intervention for workers with non-specific sub-acute low back pain

“…Loisel et al demonstrated that an occupational intervention in combination with participatory ergonomics and multidisciplinary work rehabilitation were cost-beneficial and cost-effective at mean follow-up of 6.4 years [16]. Gatchel et al showed that an early intervention program for workers who were at high risk for developing chronic LBP significantly reduced the number of work disability days and the total costs at 12-month follow-up [5].…”

“…Most economic evaluations have been performed from the societal perspective where all relevant costs are summed together without consideration for who actually pays. However, this approach has limited relevance for the company, where knowing who pays what is of critical interest and importance for decisionmaking [8,16,18,23]. From the literature, it appears that the initiation of return-to-work interventions (RTW), such as graded activity (GA) during the subacute phase of LBP (4-6 weeks after the onset of work-absenteeism) may be promising [4].…”

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

“…The only exceptions were two studies which recruited participants of a mixed duration of symptoms [30,32] two which did not specify the duration of symptoms [20], and one which recruited participants sick listed for less than 2 weeks due to LBP [31]. Most studies were conducted in the UK [32][33][34][35][36][37][38][39][40] or other European countries [21-24, 26-29, 31, 41-45]; three studies were conducted in the United States [20,30] and two in Canada [25,46]. All studies were published in English.…”

“…Most studies conducted a cost-effectiveness and/or cost-utility analysis. One study conducted a cost-effectiveness analysis as well as a costbenefit analysis [25]. Four other studies conducted a cost-benefit analysis [26][27][28][29] and two studies conducted a cost-minimization analysis [30,31].…”

Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders

“…Considering that the Workers' Compensation system and occupational disability, in general, provide an opportunity for measuring objective outcomes directly linked to resource use, greater emphasis should be placed on outcomes such as occupational status and healthcare resource use. In this regard, early work by Loisel, et al (2002) …”