Top

Published in:

Open Access 23-03-2023

Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders

Authors: Lene Aasdahl, Marius Steiro Fimland, Gudrun M.W Bjørnelv, Sigmund Østgård Gismervik, Roar Johnsen, Ottar Vasseljen, Vidar Halsteinli

Published in: Journal of Occupational Rehabilitation | Issue 3/2023

Abstract

Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up. Methods: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data. Results: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up. Conclusion: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants’ permanent disability pension awards are warranted.

Available only for authorised users

Bevan S. Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best Pract Res Clin Rheumatol. 2015;29(3):356–73. https://doi.org/10.1016/j.berh.2015.08.002

Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WE, Busse JW et al. Return-to-work coordination programmes for improving return to work in workers on sick leave. The Cochrane Database of Systematic Reviews. 2017;3(3):Cd011618. https://doi.org/10.1002/14651858.CD011618.pub2.

Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA et al. Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: An update of the evidence and messages for practitioners. Journal of Occupational Rehabilitation. 2018;28(1):1–15. https://doi.org/10.1007/s10926-016-9690-x.

Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D et al. Disability prevention: New paradigm for the management of occupational back pain. Disease Management & Health Outcomes. 2001;9:351–60.

Schultz IZ, Stowell AW, Feuerstein M, Gatchel RJ. Models of return to work for musculoskeletal disorders. Journal of Occupational Rehabilitation. 2007;17(2):327–52. https://doi.org/10.1007/s10926-007-9071-6.

Dewa CS, Hoch JS, Loong D, Trojanowski L, Bonato S. Evidence for the cost-effectiveness of return-to-work interventions for mental illness related sickness absences: A systematic literature review. Journal of Occupational Rehabilitation. 2021;31(1):26–40. https://doi.org/10.1007/s10926-020-09904-z.

Aasdahl L, Vasseljen O, Gismervik S, Johnsen R, Fimland MS. Two-year follow-up of a randomized clinical trial of inpatient multimodal occupational rehabilitation vs outpatient acceptance and commitment therapy for sick listed workers with musculoskeletal or common mental disorders. Journal of Occupational Rehabilitation. 2021. https://doi.org/10.1007/s10926-021-09969-4.

Gismervik SO, Aasdahl L, Vasseljen O, Fors EA, Rise MB, Johnsen R et al. Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial. Scand J Work Environ Health. 2020. https://doi.org/10.5271/sjweh.3882.

Fimland MS, Vasseljen O, Gismervik S, Rise MB, Halsteinli V, Jacobsen HB et al. Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial. BMC Public Health. 2014;14(1):368. https://doi.org/10.1186/1471-2458-14-368.

10.

Aasdahl L, Gismervik SO, Marchand GH, Vasseljen O, Johnsen R, Fimland MS. Changes in fear-avoidance beliefs and work participation after occupational rehabilitation for musculoskeletal- and common mental disorders: Secondary outcomes of two randomized clinical trials. J Rehabil Med. 2019. https://doi.org/10.2340/16501977-2520.

11.

Aasdahl L, Pape K, Vasseljen O, Johnsen R, Gismervik S, Halsteinli V et al. Effect of inpatient multicomponent occupational rehabilitation versus less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders: A randomized clinical trial. Journal of Occupational Rehabilitation. 2017. https://doi.org/10.1007/s10926-017-9708-z.

12.

Aasdahl L, Pape K, Vasseljen O, Johnsen R, Gismervik S, Jensen C et al. Effects of inpatient multicomponent occupational rehabilitation versus less comprehensive outpatient rehabilitation on somatic and mental health: secondary outcomes of a randomized clinical trial. Journal of Occupational Rehabilitation. 2016. https://doi.org/10.1007/s10926-016-9679-5.

13.

Aasdahl L, Pape K, Vasseljen O, Johnsen R, Fimland MS. Improved expectations about length of sick leave during occupational rehabilitation is associated with increased work participation. Journal of Occupational Rehabilitation. 2018. https://doi.org/10.1007/s10926-018-9808-4.

14.

Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ. 2022;376:e067975. https://doi.org/10.1136/bmj-2021-067975.

15.

WONCA Classification Committee CW. International Classification of Primary Care. 2nd edition ed. New York: Oxford University Press; 1998.

16.

Hara KW, Bjørngaard JH, Brage S, Borchgrevink PC, Halsteinli V, Stiles TC et al. Randomized controlled trial of adding telephone follow-up to an occupational rehabilitation program to increase work participation. Journal of Occupational Rehabilitation. 2018;28(2):265–78. https://doi.org/10.1007/s10926-017-9711-4.

17.

Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy : an experiential approach to behavior change. New York: Guilford Press; 1999.

18.

Drummond M. Introducing economic and quality of life measurements into clinical studies. Ann Med. 2001;33(5):344–9.

19.

Kaplan RS, Anderson SR. Time-driven activity-based costing: a simpler and more powerful path to higher profits. Harvard Business Press; 2007.

20.

Statistics Norway. Inflation calculator. https://www.ssb.no/kalkulatorer/priskalkulator. Accessed April 21st 2022.

21.

Norwegian Directorate of health. A guide to economic evaluation of health care interventions [In Norwegian]. Oslo 2012. Report No.: IS–1985.

22.

Robinson R. Cost-benefit analysis. BMJ. 1993;307(6909):924-6. 10.1136/bmj.307.6909.924.

23.

Statistics Norway. Wages – Occupational monthly salary, by sector, sex and working hours 2015–2021. https://www.ssb.no/statbank/table/11418/. Accessed April 5th 2022.

24.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

25.

Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129–38.

26.

Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33(5):328–36.

27.

Glick HA, Doshi JA, Sonnad SS, Polsky D. Economic evaluation in clinical trials. OUP Oxford; 2014.

28.

Finnes A, Hoch JS, Enebrink P, Dahl J, Ghaderi A, Nager A et al. Economic evaluation of return-to-work interventions for mental disorder-related sickness absence: two years follow-up of a randomized clinical trial. Scand J Work Environ Health. 2022. https://doi.org/10.5271/sjweh.4012.

29.

Bethge M, Herbold D, Trowitzsch L, Jacobi C. Work status and health-related quality of life following multimodal work hardening: a cluster randomised trial. J Back Musculoskelet Rehabil. 2011;24(3):161–72. https://doi.org/10.3233/bmr-2011-0290.

30.

Streibelt M, Bethge M. Effects of intensified work-related multidisciplinary rehabilitation on occupational participation: a randomized-controlled trial in patients with chronic musculoskeletal disorders. Int J Rehabil Res. 2014;37(1):61–6. https://doi.org/10.1097/mrr.0000000000000031.

31.

Steenstra IA, Anema JR, van Tulder MW, Bongers PM, de Vet HC, van Mechelen W. Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain. Journal of Occupational Rehabilitation. 2006;16(4):557–78. https://doi.org/10.1007/s10926-006-9053-0.

32.

Skarpsno ES, Gismervik SØ, Fimland MS, Aasdahl L. Insomnia is associated with the effect of inpatient multimodal occupational rehabilitation on work participation in workers with musculoskeletal or mental health disorders: Secondary analyses of a randomized clinical trial. Nature and Science of Sleep. 2021;13:1431.

Title: Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders
Authors: Lene Aasdahl
Marius Steiro Fimland
Gudrun M.W Bjørnelv
Sigmund Østgård Gismervik
Roar Johnsen
Ottar Vasseljen
Vidar Halsteinli
Publication date: 23-03-2023
Publisher: Springer US
Published in: Journal of Occupational Rehabilitation / Issue 3/2023
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-022-10085-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2023

Work Barriers and Job Adjustments of People with Multiple Sclerosis: A Systematic Review

Publisher Correction: Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers’ Compensation System

Who Returns to work? Exploring the Role of Interpersonal Problems in Occupational Rehabilitation

Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers’ Compensation System

Recognition During the Return-to-Work Process in Workers with Common Mental Disorders

The Job Leeway Scale: Initial Evaluation of a Self-report Measure of Health-Related Flexibility and Latitude at Work