Research short: Is integrated care value for money?

People with long term back problems, for example chronic low back pain, often remain out of the workforce for the long term.  This occurs in most industrialised countries, such as the Netherlands where this study was done, as well as Australia and the US.

The researchers of this study evaluated an intervention to help people back to work and the cost effectiveness of that intervention.

The intervention approach was an integrated one involving a physiotherapist, an occupational health service, and an occupational therapist.

About half of the 130 people in the study went through the integrated intervention program, and the other half continued with what was usually done and did not go through the integrated program.

The integrated program included:

• A workplace evaluation based on the employee and employer working together to deal with any ergonomic issues;
• A program, involving the supervisor, put in place to help the persons with back pain to gradually become more active, and to correct any misunderstandings or negative beliefs about their problems.

Sustainable return to work was measured and it was found that return to work improved in the intervention group. The researchers also studied the quality of life of the employees in the intervention versus those who did not have the intervention and found that quality of life was also improved in the intervention group. When all the costs were taken into account-- treatment, wage replacements, costs of the program, etc.-- the researchers found that the costs were substantially lower in the group that underwent the intervention than those who did not.  The researchers were able to calculate the benefit, and they found for every $1 invested in the program $26 was saved.

The researchers suggest that there are strong grounds to introduce programs such as this more broadly, including for the individual, for their families, and for society.

Authors

Lambeek LC. Bosmans JE. Van Royen BJ. Van Tulder MW. Van Mechelen W. Anema JR. .

Authors Full Name

Lambeek, Ludeke C. Bosmans, Judith E. Van Royen, Barend J. Van Tulder, Maurits W. Van Mechelen, Willem. Anema, Johannes R. .

Institution

Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.

Title

Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial.

Source

BMJ. 341:c6414, 2010.

Other ID

Source: NLM. PMC2995018

Abstract

OBJECTIVE: To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain.DESIGN: Economic evaluation alongside a randomised controlled trial with 12 months' follow-up.

SETTING: Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005-9.

PARTICIPANTS: 134 adults aged 18-65 sick listed because of chronic low back pain: 66 were randomised to integrated care and 68 to usual care.

INTERVENTIONS: Integrated care consisted of a workplace intervention based on participatory ergonomics, with involvement of a supervisor, and a graded activity programme based on cognitive behavioural principles. Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines.

MAIN OUTCOME MEASURES: The primary outcome was duration until sustainable return to work. The secondary outcome was quality adjusted life years (QALYs), measured using EuroQol.RESULTS: Total costs in the integrated care group (13165, SD 13600) were significantly lower than in the usual care group (18475, SD 13616). Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained. The cost-benefit analyses showed that every 1 invested in integrated care would return an estimated 26. The net societal benefit of integrated care compared with usual care was 5744.

CONCLUSIONS: Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs, increase effectiveness of care, improve quality of life, and improve function on a broad scale. Integrated care therefore has large gains for patients and society as well as for employers.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/21118874