Evaluating the Health and Economic Impacts of Return-to-Work Interventions: A Modeling Study

Area of Science:

• Health Economics
• Occupational Health
• Rehabilitation Medicine

Background:

• Sickness absence in Norway is at a 15-year high, necessitating effective interventions.
• Policymakers require robust data to guide decisions on high-value sick leave interventions.

Purpose of the Study:

• To assess the cost-effectiveness of two return-to-work (RTW) interventions for musculoskeletal and psychological disorders in Norway.
• To compare outpatient acceptance and commitment therapy (O-ACT) with inpatient multimodal occupational rehabilitation (I-MORE) using decision-analytic modeling.

Main Methods:

• A decision-analytic model was developed using data from 166 individuals in a randomized trial.
• The model incorporated transition probabilities, healthcare costs, production loss, and quality-adjusted life-years (QALYs) over a 25-year horizon.
• Probabilistic sensitivity analysis was used to evaluate cost-effectiveness.

Main Results:

• I-MORE facilitated quicker return to work compared to O-ACT.
• From a healthcare perspective, I-MORE was not cost-effective (98% of simulations) at a $50,000/QALY threshold.
• Including societal production loss demonstrated I-MORE to be more beneficial and less costly than O-ACT.

Conclusions:

• I-MORE is not cost-effective under current Norwegian benchmarks without considering production loss.
• Findings highlight the critical importance of adopting a societal perspective in economic evaluations for RTW interventions.
• Current Norwegian guidelines do not recommend a societal perspective, potentially limiting the evaluation of interventions like I-MORE.