Lammerts Lieke, van Dongen Johanna M, Schaafsma Frederieke G, van Mechelen Willem, Anema Johannes R
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, NL-1081 BT, The Netherlands.
Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
BMC Public Health. 2017 Feb 2;17(1):162. doi: 10.1186/s12889-017-4079-0.
Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated.
An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer's perspective. Various sensitivity analyses were performed to assess the robustness of the results.
The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer's perspective, the probability of financial return was 0.18.
From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer's perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation.
The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012.
精神障碍与生产力损失、病假缺勤及失业所带来的高昂成本相关。为提高因常见精神障碍而被列入病假名单的无劳动合同员工的复工率，制定了一项参与式支持性复工（RTW）计划。该计划采用了参与式方法、综合护理，并直接安排到有竞争力的工作岗位。本研究的目的是评估与常规护理相比，这一新计划的成本效益和成本效用。此外，还评估了其投资回报率。
在一项为期12个月的随机对照试验的同时进行了经济评估。总共186名参与者被随机分配到新计划组（n = 94）或常规护理组（n = 92）。效果指标为在有竞争力的就业中实现可持续复工的持续时间以及获得的质量调整生命年（QALY）。成本包括干预成本、医疗成本和缺勤成本。荷兰社会保障局的注册数据用于评估实现可持续复工的持续时间、干预成本和缺勤成本。使用每三个月或六个月的问卷来评估QALY和医疗成本。缺失数据采用多重填补法进行填补。从社会角度进行成本效益分析和成本效用分析。从社会保险公司的角度进行投资回报率分析。进行了各种敏感性分析以评估结果的稳健性。
新计划对实现可持续复工的持续时间和获得的QALY没有显著影响。干预组的干预成本和医疗成本显著更高。从社会角度来看，无论支付意愿如何，在实现可持续复工的持续时间方面成本效益的最大概率在支付意愿约为10000欧元/天时为0.64，在获得的QALY方面为0.27。从社会保险公司的角度来看，财务回报的概率为0.18。
从社会角度来看，新计划在改善可持续复工或获得QALY方面既不具有成本效益。从社会保险公司的角度来看，该计划没有带来正的财务回报。因此，本研究没有提供支持其实施的证据。
该试验于2012年8月7日在荷兰试验注册中心（NTR）以NTR3563的编号列出。
