Cost‐utility analysis of a multidisciplinary job retention vocational rehabilitation program in patients with chronic arthritis at risk of job loss

Abstract

Objective. To estimate from a societal perspective the cost-utility of a multidisciplinary job retention vocational rehabilitation program compared with usual care in patients with chronic rheumatic diseases at risk of job loss. Methods. Patients (n ‫؍‬ 121) were randomly assigned to either the vocational rehabilitation program or usual outpatient care initiated by the treating rheumatologist. Followup lasted for 2 years. Program costs were estimated using time registrations and other societal costs using quarterly cost questionnaires filled out by the patients. To estimate qualityadjusted life years, utility was assessed using the EuroQol classification system, EuroQol rating scale, Short Form 6D, and Time Trade-Off. Results. As part of the vocational rehabilitation program, patients on average had a total of 7.1 consultations and the total time spent by the multidisciplinary team was 12.7 hours per patient. Program costs were estimated at €1,426, of which ϳ20% were time and travel costs incurred by the patients. No significant differences were found in other health care consumption, productivity, or quality-adjusted life years. Program costs were outweighed by total savings on other health care and nonhealth care costs, but not significantly. Conclusion. From a societal perspective, it remains unclear whether the program reduces or increases total costs. Further research on effective vocational rehabilitation is warranted, with special attention to early detection of work problems and the collaboration between health care and vocational rehabilitation services.

Productivity estimation in economic evaluations of occupational health and safety interventions: a systematic review

“…A generic national or regional price weight was used in 13 studies (19%), 9 (13%) used a worker-specific weight, 3 (4%) the industry or company average, and 1 (1%) a job average with age differentiation. Variations -such as using the mean annual salary per staff member in the NHSL (47), the study group average (75, 100), or the national average (41, 45,48,56,60,62,64,(66)(67)(68)(69)(70)72,(83)(84)(85)87,89,93,95,97,99,103,107,(118)(119)(120)(121)(122)(123)(124) 47,63,65,74,(77)(78)(79)81,82,87,(100)(101)(102)108,109,112,114,117,(126)(127)(128) (48, 52, 53, 58, 65-67, 69,...…”

“…Steel et al 39-42, 45-49, 51-54, 56-58, 60-75, 77-91, 93-128) Source absenteeism Firm data 26 (45, 46, 54, 57, 67-69, 71, 85, 86, 88, 91, 95, 96, 100, 101, 105, 107, 110, 114-116, 119, 125-127 (39, 42,49,51,56,57,62,64,66,72,78,79,81,82,87,89,94,102,104,109,113,117,118,(121)(122)(123)) Previous studies 10 (52, 53, 60, 61, 63, 83, 84, 99, 111, 120) Insurance data 9 (47, 48, 58, 60, 74, 75, 80, 112, 124 39, 42,49,56,72,79,81,82,102,104,109,117 11 (41, 56, 62, 93, 100, 107, 118, 119, 121-123) Estimated by the author 1 (88) The Chartered Institute of Personnel and Development 1 (108)…”

Persistent musculoskeletal pain and productive employment; a systematic review of interventions

“…The rehabiliation programme did not result in reduced job loss and evidence quality for this outcome was assessed as low. Although van den Hout et al 40 reported reduced costs of rehabilitation compared to usual care, the findings were not significant and evidence quality was low.…”

“…The education package contained information about return to work options and a questionnaire to measure outcomes. The study by van den Hout et al 40 concluded that a multidisciplinary rehabilitation intervention had no effect on the sick leave of individuals with PMP. One study42 assessed the impact of an individually-focused intervention on job loss, the same study also measured pain as an outcome.…”

“…Usual care involved referral of individuals to outpatient services, which occurs as standard practice40 42 or being provided with written information 41. Individually-focused interventions included an education package41 and multidisciplinary rehabilitation 40 42. Three outcomes were assessed: sick leave, job loss and cost benefit.…”