Cost-effectiveness and cost-benefit analyses of a multidisciplinary intervention compared with a brief intervention to facilitate return to work in sick-listed patients with low back pain.

STUDY DESIGN: Randomized clinical trial of 2 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 health care 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 rates in a brief and a multidisciplinary intervention group, but different return to work 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 on the basis of registers.

RESULTS: The mean intervention cost per patient was € 1377 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 1 saved sick leave week in this subgroup (n = 60) of patients, who thought they were at risk of losing their job or had little influence on their work situation was € 217. The latter finding was verified in the validation study (n = 28).

CONCLUSION: 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 thought they were at risk of losing their job or had little influence on their work situation.

LEVEL OF EVIDENCE: 2.