Abstract
A cluster-randomized controlled trial, WorkUp, was conducted for working-aged patients at risk of sick leave or on short-term sick leave due to acute/subacute neck and/or back pain in Sweden. The purpose of WorkUp was to facilitate participants to stay at work or in case of sick leave, return-to-work. The aim of this study was to study whether the WorkUp trial was cost-effective. Patients in the intervention and reference group received structured evidence-based physiotherapy, while patients in the intervention group also received a work place dialogue with the employer as an add-on. The participants, 352 in total, were recruited from 20 physiotherapeutic units in primary healthcare in southern Sweden. The economic evaluation was performed both from a healthcare and a societal perspective with a 12-month time frame with extensive univariate sensitivity analyses. Results were presented as incremental cost–effectiveness ratios (ICER) with outcomes measured as quality-adjusted life-years (QALY) and proportion working for at least 4 weeks in a row without reported sick leave at 12-month follow-up. From the healthcare perspective, the ICER was €23,606 (2013 price year) per QALY gain. From the societal perspective the intervention was dominating, i.e.. less costly and more effective than reference care. Bootstrap analysis showed that the probability of the intervention to be cost-effective at €50,000 willingness-to-pay per QALY was 85% from the societal perspective. Structured evidence-based physiotherapeutic care together with workplace dialogue is a cost-effective alternative from both a societal and a healthcare perspective for acute/subacute neck and/or back pain patients.Trial registration ClinicalTrials.gov: NCT02609750.
Highlights
Musculoskeletal pain (MSP) is one of the most common causes of sick leave in the Western world
Power analyses were performed based on the primary outcome work ability, where sick leave was estimated to be decreased by 30% in the intervention group and 10%
There was a significant higher increase in quality-adjusted life-years (QALY) after months in the intervention group compared to the reference group (0.033, p = 0.01) using the Swedish tariff (Table 2). 86% of the participants in the intervention group scored positively on the work ability outcome “working for at least 4 weeks in a row at 12-month follow-up without reported sick leave” compared to 74% of the reference group (p = 0.01)
Summary
Musculoskeletal pain (MSP) is one of the most common causes of sick leave in the Western world. It is important to identify how individuals with MSP can maintain or regain ability to work as well as Return-To-Work (RTW) from sick leave. The WorkUp trial (ClinicalTrials.gov: NCT02609750), was conducted in southern Sweden during 2013–2015. It was a cluster Randomized Controlled Trial (RCT) targeting working-aged patients with acute/subacute neck and/or back pain and at risk for sick leave or on shorter sick leave. Using structured physiotherapeutic interventions and a workplace intervention termed “Convergence Dialogue Meetings” (CDM) which integrated an early dialogue with the employer to identify the needs for workplace adjustments, the intervention aimed to maintain work ability or, if sick-listed, facilitate RTW.
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