Economic Evaluation of a Participatory Return-to-Work Intervention for Temporary Agency and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders

Article excerpt

Objective The aim of the study was to evaluate the cost-effectiveness, -utility, and -benefit of a newly developed participatory retum-to-work (RTW) program for temporary agency and unemployed workers, sick-listed due to musculoskeletal disorders.

Methods An economic evaluation was conducted alongside a randomized controlled trial with a 12-month follow-up. Temporary agency and unemployed workers, sick-listed for 2-8 weeks due to musculoskeletal disorders, were randomized to the participatory RTW program (N=79) or usual care group (N=84). The new RTW program was aimed at making a consensus-based RTW action plan with the possibility of a temporary (therapeutic) workplace. Effect outcomes were sustainable RTW and quality-adjusted life years (QALY). Healthcare utilization was measured from the social insurer's perspective and societal perspective.

Results Total healthcare costs in the participatory RTW program group [10 189 (standard deviation [SD] 7055) euros] were statistically significantly higher compared to care-as-usual [7862 (SD 7394) euros]. The cost-effectiveness analyses showed that the new intervention was more effective but also more costly than usual care (ie, to gain RTW one day earlier in the participatory RTW program group, approximately 80 euros needed to be invested). The net societal benefit of the participatory RTW program compared to care-as-usual was 2073 euros per worker.

Conclusions The newly developed participatory RTW program was more effective but also more costly than usual care. The program enhanced work resumption and generated a net socioeconomic benefit. Hence, implementation of the participatory RTW program may have potential to achieve a sustainable contribution of vulnerable workers to the labor force.

Key terms cost-effectiveness analysis; cost-benefit analysis; labor force participation; social insurer perspective; societal perspective; sustainable return-to-work; vulnerable worker population; worker without employment contract.

The socioeconomic impact of musculoskeletal disorders (MSD) among the working population is significant. Findings in the international literature consistently have shown that MSD-related long-term sickness absence, ie, chronic work disability, accounts for the majority of these societal costs (1-5). Direct healthcare costs represent only a minor part of the economic burden.

To achieve evidence-based and efficient occupational healthcare it is essential to gain insight into the relationship between the input of financial resources and the achieved results. From this perspective, there is a forthcoming demand for methodological high quality economic evaluation of occupational healthcare interventions (6, 7). The key question is whether the beneficial effect(s) of a (newly developed) intervention is worth the (extra) costs, when compared to, for instance, usual care. After all, provided the presence of substantial effects, an intervention with higher costs can still be cost-effective. Conversely, a low-cost intervention is not necessarily the most cost-effective.

Within the field of occupational healthcare research, development of return-to-work (RTW) interventions for sick-listed workers with non-standard labor agreements (eg, temporary agency and unemployed workers) is uncommon (8). In contrast, the number of non-standard workers is rapidly growing. To illustrate: in 1998 the private employment agency industry constituted of approximately 4.8 million agency workers [fulltime equivalent (FTE)] worldwide (9). Ten years later, in 2008, this number had nearly doubled to 9.5 million agency workers (FTE) across the globe (9). In addition, in the Netherlands in 2008, nearly 3300 private employment agencies provided 242 000 fulltime jobs (daily average number of FTE). These workers with non-standard labor agreements, however, represent a vulnerable group within the working population as they are characterized by a poorer health status, a greater distance to the labor market, and an increased risk for (long-term) work disability (10). …

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