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Title: Cost effectiveness of a return to work program for workers on sick leave due to low back pain.

Authors and affiliation: Steenstra, IA1,2,3,4 Anema, JR1,2,4, Bongers, PM1,3,4, de Vet, HCW1, van Tulder, MW1 , van Mechelen, W1,2,4

1 Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands,
2 Department of Social Medicine VU University Medical Center,
3 TNO Work and Employment,
4 Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc,

Email address: i.a.steenstra@amc.uva.nl

Introduction: Little is known on cost-effectiveness of interventions in low back pain (LBP)

Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to LBP, comparing a participatory ergonomics program implemented between 2-8 weeks of sick-leave with usual occupational care, and a clinical intervention after 8 weeks of sick-leave with usual occupational care.

Methods: Design: Economic evaluation alongside a randomised controlled trial (RCT).
Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP aged 42.6 on average. Workers from all groups were comparable on all measured potential prognostic factors in every comparison made.
Interventions: 1. a participatory ergonomics program. 2. graded activity 3. usual occupational care. Outcome measures were lasting return to work (RTW), 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.

Results: The participatory ergonomics group (n=96) returned to work 30.0 days (95% CI=[3.1-51.3]) earlier than the usual care group (n=100) at higher costs (ratio of 1 day: €19). Workers in the graded activity group that had received usual care in the first 8 weeks (n=28) returned to work 21.3 days (95% CI= [-74.1, 29.2]) later then the group with usual care only (n=32). The group that had received participatory ergonomics in the first 8 weeks and graded activity after 8 weeks (n=27) returned to work 50.9 days (95% CI=[-89.4, -2.7]) later then the group that received participatory ergonomics in the first 8 week and usual care after 8 weeks (n=25). Participatory ergonomics was more effective than usual occupational care in RTW at slightly higher costs and was more effective than usual care at equal costs on improving functional status and quality of life, but was not effective on pain intensity and general health. Graded activity was less effective than usual care and associated with higher costs.

Conclusion: Participatory ergonomics is a cost-effective treatment option resulting in a faster RTW for this group of workers.