Alexander Tingulstad, Esther T Maas, Tarjei Rysstad, Britt Elin Øiestad, Fiona Aanesen, Are Hugo Pripp, Maurits W Van Tulder, Margreth Grotle
{"title":"在肌肉骨骼疾病工人的常规病例管理中增加动机性访谈或分层职业咨询干预的六个月成本效益:MI-NAV经济评估","authors":"Alexander Tingulstad, Esther T Maas, Tarjei Rysstad, Britt Elin Øiestad, Fiona Aanesen, Are Hugo Pripp, Maurits W Van Tulder, Margreth Grotle","doi":"10.1186/s12995-023-00394-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates the six-month cost-effectiveness and cost-benefits of motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) added to usual case management (UC) for workers on sick leave due to musculoskeletal disorders.</p><p><strong>Methods: </strong>This study was conducted alongside a three-arm RCT including 514 employed workers on sick leave for at least 50% for ≥ 7 weeks. All participants received UC. The UC + MI group received two MI sessions, and the UC + SVAI group received 1-4 SVAI sessions. Sickness absence days, quality-adjusted life-years (QALYs), and societal costs were measured between baseline and six months.</p><p><strong>Results: </strong>Adding MI to UC, resulted in incremental cost-reduction of -2580EUR (95%CI -5687;612), and a reduction in QALYs of -0.001 (95%CI -0.02;0.01). Secondly, adding MI to UC resulted in an incremental cost-reduction of -538EUR (95%CI -1358;352), and reduction of 5.08 (95%CI -3.3;13.5) sickness-absence days. Financial return estimates were positive, but not statistically significant. Adding SVAI to UC, resulted in an incremental cost-reduction of -2899 EUR (95% CI -5840;18), and a reduction in QALYs of 0.002 (95% CI -0.02;0.01). Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90).</p><p><strong>Conclusions: </strong>In comparison to UC only, adding MI to UC tends to be cost-effective. 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Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90).</p><p><strong>Conclusions: </strong>In comparison to UC only, adding MI to UC tends to be cost-effective. 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引用次数: 0
摘要
目的:本研究评估了六个月的成本效益和成本效益，动机访谈(MI)或分层职业咨询干预(SVAI)添加到通常病例管理(UC)中，用于因肌肉骨骼疾病而请病假的工人。方法:本研究与一项三臂随机对照试验一起进行，包括514名病假至少50%≥7周的受雇工人。所有参与者均获得UC。UC + MI组接受2次MI治疗，UC + SVAI组接受1-4次SVAI治疗。在基线至6个月期间测量病假天数、质量调整生命年(QALYs)和社会成本。结果:在UC中加入MI，导致成本减少-2580欧元(95%CI -5687;612)， qaly减少-0.001 (95%CI -0.02;0.01)。其次，在UC中加入MI可增加成本减少-538欧元(95%CI -1358;352)，减少5.08天(95%CI -3.3;13.5)病假天数。财务回报估计是正的，但在统计上不显著。将SVAI添加到UC中，导致增加的成本减少-2899欧元(95% CI -5840;18)， QALYs减少0.002 (95% CI -0.02;0.01)。其次，将SVAI添加到UC中导致统计上显著的成本减少-695欧元(95% CI -1459;-3)，减少7.9 (95% CI -0.04;15.9)病假天数。财务回报估计是积极的，具有统计学意义。添加MI或SVAI后，qaly的成本-效果概率较高(上限比0.90)。结论:与单纯UC相比，在UC中加入MI更具成本效益。在UC中添加SVAI对于因肌肉骨骼疾病而请病假的工人来说是具有成本效益的。试验注册:ClinicalTrials.gov(标识符:NCT03871712)。
Six-month cost-effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management for workers with musculoskeletal disorders: the MI-NAV economic evaluation.
Objectives: This study evaluates the six-month cost-effectiveness and cost-benefits of motivational interviewing (MI) or a stratified vocational advice intervention (SVAI) added to usual case management (UC) for workers on sick leave due to musculoskeletal disorders.
Methods: This study was conducted alongside a three-arm RCT including 514 employed workers on sick leave for at least 50% for ≥ 7 weeks. All participants received UC. The UC + MI group received two MI sessions, and the UC + SVAI group received 1-4 SVAI sessions. Sickness absence days, quality-adjusted life-years (QALYs), and societal costs were measured between baseline and six months.
Results: Adding MI to UC, resulted in incremental cost-reduction of -2580EUR (95%CI -5687;612), and a reduction in QALYs of -0.001 (95%CI -0.02;0.01). Secondly, adding MI to UC resulted in an incremental cost-reduction of -538EUR (95%CI -1358;352), and reduction of 5.08 (95%CI -3.3;13.5) sickness-absence days. Financial return estimates were positive, but not statistically significant. Adding SVAI to UC, resulted in an incremental cost-reduction of -2899 EUR (95% CI -5840;18), and a reduction in QALYs of 0.002 (95% CI -0.02;0.01). Secondly, adding SVAI to UC resulted in an statistically significant incremental cost-reduction of -695 EUR (95% CI -1459;-3), and a reduction of 7.9 (95% CI -0.04;15.9) sickness absence days. Financial return estimates were positive and statistically significant. The probabilities of cost-effectiveness for QALYs were high for adding MI or SVAI (ceiling ratio 0.90).
Conclusions: In comparison to UC only, adding MI to UC tends to be cost-effective. Adding SVAI to UC is cost-effective for workers on sick leave due to musculoskeletal disorders.
期刊介绍：
Aimed at clinicians and researchers, the Journal of Occupational Medicine and Toxicology is a multi-disciplinary, open access journal which publishes original research on the clinical and scientific aspects of occupational and environmental health.
With high-quality peer review and quick decision times, we welcome submissions on the diagnosis, prevention, management, and scientific analysis of occupational diseases, injuries, and disability. The journal also covers the promotion of health of workers, their families, and communities, and ranges from rehabilitation to tropical medicine and public health aspects.
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