一项多方面工作场所干预措施对减轻护理人员肌肉骨骼疼痛的成本效益分析：一项整群随机对照试验（INTEVAL_Spain）

Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain).

作者信息

Soler-Font Mercè, Aznar-Lou Ignacio, Almansa Josué, Peña Pilar, Silva-Peñaherrera Michael, Serra Consol, Ramada José Maria

机构信息

Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.

CIBER of Epidemiology and Public Health, Madrid, Spain.

出版信息

J Occup Rehabil. 2024 Aug 5. doi: 10.1007/s10926-024-10227-6.

DOI:10.1007/s10926-024-10227-6

PMID:39102106

Abstract

PURPOSE

To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff.

METHODS

The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed.

RESULTS

Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group.

CONCLUSION

This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings.

STUDY REGISTRATION

ISRCTN15780649, retrospectively registered.

摘要

目的

评估多方面工作场所干预措施对降低护理人员肌肉骨骼疼痛（MSP）的成本效益。

方法

该研究为为期1年的整群随机对照试验。干预措施结合了参与式人体工程学、健康促进和病例管理。对照组接受常规护理。采用社会和卫生系统视角。成本包括直接医疗成本和间接成本。效果指标为MSP和质量调整生命年（QALY）。在基线、6个月和12个月随访时，使用标准化北欧问卷测量MSP。在6个月和12个月随访时，使用欧洲五维度健康量表（EuroQol-5D-3L）测量QALY。使用广义线性模型对增量成本和QALY进行建模。通过广义逻辑模型分析MSP。计算增量成本效益比（ICER），并构建成本效益平面和可接受性曲线。

结果

从社会视角来看，干预组和对照组人均总平均成本分别为614欧元和216欧元。干预组平均成本为每人38欧元。从社会视角来看，ICER显示，要使MSP额外降低1个百分点，总体上需要额外花费68欧元（从卫生系统视角为9欧元）。对于颈部、肩部和上背部疼痛，从社会视角和卫生系统视角的ICER分别为34欧元和4欧元；对于下背部疼痛，分别为53欧元和7欧元；对于手部疼痛，分别为179欧元和23欧元；对于腿部疼痛，分别为39欧元和5欧元；对于膝盖疼痛，分别为115欧元和14欧元；对于足部疼痛，分别为36欧元和5欧元；对于肘部MSP，分别为36欧元和5欧元。对于肘部疼痛的参与者以及QALY，ICER显示干预组被对照组主导。