Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevägen 2, 22381, Lund, Sweden.
Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
Eur J Health Econ. 2019 Mar;20(2):317-327. doi: 10.1007/s10198-018-1003-1. Epub 2018 Aug 31.
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.
一项在瑞典开展的工作年龄患者的整群随机对照试验（WorkUp），这些患者因急性/亚急性颈痛和/或背痛而面临请病假或短期病假的风险。WorkUp 的目的是帮助参与者继续工作或在请病假的情况下返回工作岗位。本研究旨在研究 WorkUp 试验是否具有成本效益。干预组和对照组的患者均接受基于证据的结构化物理治疗，而干预组的患者还接受了与雇主的工作场所对话作为附加治疗。总共招募了 352 名参与者，他们来自瑞典南部 20 个初级保健中的物理治疗单位。经济性评估从医疗保健和社会两个角度进行，时间范围为 12 个月，并进行了广泛的单变量敏感性分析。结果以增量成本效益比（ICER）表示，结果以质量调整生命年（QALY）和在 12 个月随访时至少连续 4 周无报告病假的工作比例来衡量。从医疗保健角度来看，每增加一个 QALY 的成本效益比为 23606 欧元（2013 年价格）。从社会角度来看，干预措施具有优势，即比参考护理更具成本效益。 自付意愿为 50000 欧元/QALY 时，从社会角度来看，干预措施具有成本效益的概率为 85%。从社会和医疗保健的角度来看，结构化的循证物理治疗与工作场所对话是一种具有成本效益的替代方案，适用于急性/亚急性颈痛和/或背痛患者。
ClinicalTrials.gov：NCT02609750。
