Steenstra Ivan A, Anema Johannes R, van Tulder Maurits W, Bongers Paulien M, de Vet Henrica C W, van Mechelen Willem
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
J Occup Rehabil. 2006 Dec;16(4):557-78. doi: 10.1007/s10926-006-9053-0.
To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care.
Economic evaluation alongside a randomised controlled trial (RCT).
Workers sick-listed for a period of 2 to 6 weeks due to LBP.
The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2-6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave.
The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: 19 euro). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [-74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[-89.4, -2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs.
The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.
评估针对因腰痛（LBP）而休病假的员工的重返工作岗位（RTW）计划的成本效益和成本效用，比较在病假2至8周之间实施的工作场所干预与常规护理，以及病假8周后实施的临床干预与常规护理。
与随机对照试验（RCT）同时进行的经济评估。
因LBP而病假2至6周的员工。
主要结果是重返工作岗位（RTW）。其他结果包括疼痛强度、功能状态、生活质量和总体健康状况。经济评估从社会角度进行。在基线（病假2 - 6周后）以及病假第一天后的12周、26周和52周对结果进行评估。
工作场所干预组平均比常规护理组提前30.0天（95%置信区间=[3.1, 51.3]）重返工作岗位，直接成本略高（1天的比例为19欧元）。在最初8周接受常规护理的临床干预组员工平均晚21.3天（95%置信区间=[-74.1, 29.2]）重返工作岗位。在最初8周接受工作场所干预且8周后接受临床干预的组平均晚50.9天（95%置信区间=[-89.4, -2.7]）重返工作岗位。工作场所干预在RTW方面比常规护理更有效，成本略高，在其他结果方面，在成本相同的情况下与常规护理效果相当。临床干预比常规护理效果更差且成本更高。
对于因LBP而休病假两至六周的员工，工作场所干预以合理成本带来比常规护理更安全、更快的RTW。
