Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress.

Marijke Keus Van De Poll,Lydia Kwak,Caroline Lornudd,Malin Lohela-Karlsson,Lotta Nybergh,Gunnar Bergström,Irene Jensen

doi:10.3390/ijerph17145234

Abstract

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer’s perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer’s perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

Highlights

Common mental disorders (CMD, i.e., depression, anxiety and adjustment disorders) are highly prevalent and are associated with a total cost estimated to be more than 4% of the GDP across the EU countries
The result indicated that problem-solving based intervention (PSI) was a cheaper intervention than care as usual (CAU) but that costs related to short-term sickness absence and production loss due to ill health, i.e., costs that occur while employees are at work, were higher for PSI, whereas the cost related to long-term sickness absence was higher for CAU
A structured work-directed intervention based on problem solving for employees with common mental disorders (CMD) leads to fewer long-term sickness absence days and a faster return to work (RTW)

Summary

Introduction

Common mental disorders (CMD, i.e., depression, anxiety and adjustment disorders) are highly prevalent and are associated with a total cost estimated to be more than 4% of the GDP across the EU countries. Of this cost, only 1.3% of the GDP is spent directly on health care, while the rest is comprised of indirect costs associated with social security programs, lower employment on the labor market and production loss among employees that are sick at work or on sickness absence due to CMD [1]. Work-directed interventions should lead to better health, improved work ability and reduced costs related to sickness absence and production loss at work, i.e., reduced production due to ill health while at work

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Conclusion