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Cost-effectiveness and cost-benefit of a multidisciplinary intervention compared to a brief intervention to facilitate return to work in sick-listed low-back pain patients [with consumer summary]
Jensen C, Nielsen CV, Jensen OK, Petersen KD
Spine 2013 Jun 1;38(13):1059-1067
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized clinical trial (RCT) of two interventions in 351 employees sick-listed due to low-back pain (LBP) and a subsequent validation study (n = 120) to validate results from subgroup analyses in the original study. OBJECTIVE: To compose health economic analyses (cost-effectiveness- and cost-benefit analyses) of multidisciplinary versus brief intervention by calculating healthcare sector costs and sick leave benefits. SUMMARY OF BACKGROUND DATA: Both brief and multidisciplinary interventions have been reported to be superior relative to usual care when comparing intervention costs with saved costs for sick leave benefits. We reported similar return to work (RTW) rates in a brief and a multidisciplinary intervention group, but different RTW rates in subgroups. METHODS: The brief intervention comprised clinical examination and reassuring advice. The multidisciplinary intervention was conducted by a case manager and a team of specialists. The costs of medicine, health care services and sick leave benefits were calculated based on registers. RESULTS: The mean intervention cost per patient was Euro 1,377 higher in the multidisciplinary intervention (n = 176) than in the brief intervention group (n = 175) and sick leave was not averted. However, sick leave was averted in a subgroup receiving the multidisciplinary intervention and the mean incremental intervention cost for one saved sick leave week in this subgroup (n = 60), who felt at risk of losing their job or had little influence on their work situation was Euro 217. The latter finding was verified in the validation study (n = 28). CONCLUSIONS: The brief intervention resulted in fewer sick leave weeks and was less expensive than the multidisciplinary intervention. The multidisciplinary intervention only outperformed the brief intervention in terms of costs in a subgroup of sick-listed employees who felt at high risk of losing their job or had little influence on their work situation.
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