Objective To evaluate the cost-effectiveness of a multifaceted workplace intervention to prevent musculoskeletal pain (MSP) in nursing staff.

Methods The study was a one-year cluster randomized controlled trial and encompassed participatory ergonomics, health promotion and case management. Control group received usual care. The societal and the Health System perspectives were used. Costs included direct health costs and indirect costs. The outcomes were MSP, sickness absence and Quality-Adjusted Life Years (QALYs). MSP was measured with the Standardized Nordic Questionnaire at baseline, six and 12-month follow-ups. Sickness absence data were obtained from Human Resources database. QALYs were measured using the EuroQol-5D-3L at six and 12-month follow-ups. Incremental costs and effectiveness were modelled by GEE models and adjusted for sex, age, occupation and baseline values. Incremental cost-effectiveness ratios (ICERs) were calculated.

Results Total direct health costs were €102.80 and €73.57 for the intervention and control groups, respectively. The intervention costs were €27.96 per nurse and/or nursing aide. Neck, shoulders and upper back showed a statistically significative difference of 20 percentual points of MSP. From the societal perspective, the ICER in terms of MSP in the former anatomical site was €3.63 (€1.69 Health system perspective) to achieve 1-extra percentual point reduction of MSP. ICER were €60.58 and €28.21 for MSP in hands from societal and health system perspectives respectiely; €11.18 and €5.21 respectively in legs; and €12.98 and €6.04 respectively in feet. In both societal and health system perspectives, the ICER was dominated by usual care for low-back pain, elbows, knees, sickness absence and QALY.

Conclusion The intervention was cost-effective to reduce MSP in neck, shoulders and upper back at 12-month follow-up compared to the control group. Health systems and society could implement this kind of multifaceted interventions in the workplace for nursing staff since the additional cost required to improve MSP seems to be low and affordable.