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An occupational health intervention program for workers at high risk for sickness absence. Cost-effectiveness analysis based on a randomised controlled trial.
  1. Simo Taimela (simo.taimela{at}evalua.fi)
  1. Evalua International, Finland
    1. Selina Justen (selina.justen{at}evalua.fi)
    1. Evalua International, Finland
      1. Pasi Aronen
      1. University of Helsinki, Department of Public Health, Finland
        1. Harri Sintonen
        1. University of Helsinki, Department of Public Health, Finland
          1. Esa Läärä
          1. University of Oulu, Department of Mathematical Sciences, Finland
            1. Antti Malmivaara
            1. Finnish Office for Health Technology Assessment, FinOHTA/Stakes, Finland
              1. Jaakko Tiekso
              1. Evalua International, Finland
                1. Timo Aro
                1. Mutual Pension Insurance Company Ilmarinen, Finland

                  Abstract

                  Objectives: To determine whether, from the healthcare perspective, a specific occupational health intervention is cost-effective in reducing sickness absence when compared with usual care at occupational health in workers with high risk of sickness absence. Methods: Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n=209) or to usual care (n=209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for altogether 384 subjects and questionnaire data on health care costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct health care costs up to 12 months after randomisation. Cost-effectiveness (CE) was expressed as an incremental CE ratio, CE plane, and CE acceptability curve with both available direct total cost data and missing total cost data imputed. Results: After one year, the mean of sickness absence was 30 days in the usual care group (n=192) and 11 days less (95% confidence interval 1 to 20 days) in the intervention group (n=192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost €974 and €1049 in the intervention group (n=134) and in the usual care group (n=138), respectively. The intervention turned out to be dominant, i.e., both cost saving and more effective than usual occupational health care. The saving was 43 € per sickness absence day avoided with available direct total cost data, and 17 € with missing total cost data imputed. Conclusions: One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is cost-effective use of health care resources. Trial Registration: ClinicalTrial.gov NCT00378989

                  • cost effectiveness
                  • intervention
                  • occupational health
                  • randomised trial
                  • sickness absence

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