Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): a cost-effectiveness analysis comparing team-based rehabilitation in primary care vs treatment as usual.

Abstract

Background: The PREVention of Sickness Absence through early identification and rehabilitation of at-risk patients with Musculoskeletal disorders (PREVSAM) model for team-based rehabilitation in primary care of patients with higher risk for sickness absence was investigated in a randomised controlled trial. Participants were screened with the Örebro Musculoskeletal Pain Screening Questionnaire - short form using a minimum value of 40 points for inclusion in the trial.

Methods: This cost-effectiveness analysis (CEA) was performed alongside the PREVSAM trial from both healthcare and societal perspectives regarding costs in relation to change in quality-adjusted life-years (QALYs) over one year for groups receiving care according to the PREVSAM model and treatment as usual.

Results: Both team-based rehabilitation and treatment as usual led to similar QALYs over one year. From the healthcare perspective, the PREVSAM model was somewhat more costly, with higher rehabilitation costs not being fully outweighed by lower costs for other primary care, specialised care, and medication. From the societal perspective, there was essentially no difference in total costs, as lower production loss costs essentially compensated for the higher rehabilitation costs. The probability that the PREVSAM model is cost-effective was close to 50% across conventional Swedish cost-effectiveness thresholds (€43 000 to €86 000 per QALY).

Conclusions: The PREVSAM model and treatment as usual led to similar health outcomes and to similar total societal costs. Neither strategy was shown to be preferable on economic grounds at conventional cost-effectiveness thresholds. High individual variation implies that the screening process needs to be further refined to better identify those patients truly in need of team-based care and to facilitate appropriate resource stratification.

Trial registration: The trial was registered with ClinicalTrials.gov, Protocol ID: NCT03913325. Study Registration Date, First submitted 09/04/2019, First posted 12/04/2019.