J.M. van Dongen

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re‐)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non‐randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI −49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI −112%, BCR −0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI −92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.

Trial-Based Economic Evaluations in Occupational Health: Principles, Methods, and Recommendations

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Economic Evaluation of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Results of a Randomized Controlled Trial.

Objective: To evaluate the cost-effectiveness of a Web-based guided intervention compared with care as usual for employees with depressive symptoms. Methods: A total of 231 employees with depressive symptoms were randomized. Data were collected at baseline, 8 weeks, 6 months, and 12 months. Analyses were conducted from the societal and employers perspective. Results: At 12 months, a significant intervention effect on depressive symptoms was found. At a willingness to pay of 0 (&OV0556;/unit of effect), the interventions probabilities of cost-effectiveness were 0.62 (societal perspective) and 0.55 (employers perspective). There was a 0.63 probability that the intervention resulted in a positive financial return for the employer. Conclusions: The interventions cost-effectiveness with regard to depressive symptoms depends on the willingness to pay of societal and company decision makers as well as the probability of cost-effectiveness that they consider acceptable. The intervention is not cost-saving to the employer.

Insights into the concept of vitality: associations with participation and societal costs

BACKGROUND In healthcare, the focus is currently shifting from someones disabilities to someones abilities, which is also evident from the increasing focus on vitality. Vitality (here defined as energy, motivation and resilience) is an often used concept, which also aims at someones capabilities. However, little is known about vitality yet; in particular about its association with participation and societal costs. METHODS Within a cross-sectional design, information regarding vitality, participation and societal costs was collected among 8015 Dutch adults aged 20 years and over. Vitality was measured using the validated Dutch Vitality Questionnaire (Vita-16). Information on economic (i.e. want/able to work, work absenteeism, work performance), societal (i.e. voluntary work, informal care giving) and social participation (i.e. quantity and quality of social contacts) and societal costs (i.e. healthcare and work-related costs) was collected using an internet survey. RESULTS Significant associations were found between vitality and various economic (i.e.sustainable employability:want to work: β = 1.21, 95% CI: 0.99-1.43,able to work:β = 2.09, 95% CI: 1.79-2.38;work absenteeism: OR = 0.75, 95% CI: 0.71-0.79;work performance:β = 0.49, 95% CI: 0.46-0.52), societal (i.e.voluntary work, informal care) and social (i.e.quantity and quality of social contacts) participation measures, as well as between vitality and societal costs (i.e.healthcare costs:β = -213.73, 95% CI: €-311.13 to €-107.08),absenteeism costs: β = -338.57, 95% CI: €-465.36 to €-214.14 and presenteeism costs:β = -1293.31, 95% CI: €-1492.69 to €-1088.95). CONCLUSION This study showed significant positive associations between vitality and economic, societal and social participation and negative associations between vitality and societal costs. This may stimulate research on interventions enhancing and maintaining vitality and thereby contributing to improved participation and reduced costs.

Cost-effectiveness of a combined physical exercise and psychosocial training intervention for children with cancer: Results from the quality of life in motion study.

&NA; This study was performed to estimate the cost‐effectiveness of a combined physical exercise and psychosocial intervention for children with cancer compared with usual care. Sixty‐eight children, aged 8‐18 years old, during or within the first year post‐cancer treatment were randomised to the intervention (n = 30) and control group (n = 38). Health outcomes included fitness, muscle strength and quality adjusted life years; all administered at baseline, 4‐ and 12‐month follow‐up. Costs were gathered by 1 monthly cost questionnaires over 12 months, supplemented by medication data obtained from pharmacies. Results showed no significant differences in costs and effects between the intervention and control group at 12‐month follow‐up. On average, societal costs were &U20AC;299 higher in the intervention group than in the control group, but this difference was not significant. Cost‐effectiveness acceptability curves indicated that the intervention needs large societal investments to reach reasonable probabilities of cost‐effectiveness for quality of life and lower body muscle strength. Based on the results of this study, the intervention is not cost‐effective in comparison with usual care.

Patient versus general population health state valuations: a case study of non-specific low back pain

PurposeThe purpose of this study was twofold: (1) to compare non-specific low back pain (LBP) patients’ health state valuations with those of the general population, and (2) to explore how aspects of health-related quality of life as measured by the EQ-5D-3L impact non-specific LBP patient valuations.MethodsData were used of a randomized controlled trial, including 483 non-specific LBP patients. Outcomes included the EQ-VAS and the EQ-5D-3L. Patient valuations were derived from the EQ-VAS. Population valuations were derived from the EQ-5D-3L using a Dutch VAS-based tariff. The difference between patient and population valuations was assessed using t tests. An OLS linear regression model was constructed to explore how various aspects of health-related quality of life as measured by the ED-5D-3L impact non-specific LBP patient valuations.ResultsNon-specific LBP patients valued their health states 0.098 (95% CI 0.082–0.115) points higher than the general population. Only 22.2% of the variance in patient valuations was explained by the patients’ EQ-5D-3L health states (R2 = 0.222). Non-specific LBP patients gave the most weight to the anxiety/depression dimension.ConclusionsThis study demonstrated that non-specific LBP patients value their health states higher than members of the general population and that the choice of valuation method could have important implications for cost-effectiveness analyses and thus for clinical practice.

Economic Evaluation of Intensive Inpatient Treatments for Severely Obese Children and Adolescents.

Background: Considering the large economic consequences of severe childhood obesity for the society, we aimed to conduct an economic evaluation comparing two intensive 1-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to standard deviation score BMI (SDS-BMI) and quality-adjusted life years (QALYs). Methods: An economic evaluation from a societal perspective accompanying a randomized controlled trial with a 24-month follow-up. 80 participants (8-19 years) with severe obesity were included. Participants received an intensive 1-year lifestyle treatment with an inpatient period of 2 months (short-stay group) or 6 months (long-stay group). Data were collected at baseline, 6, 12 ,and 24 months and included SDS-BMI and QALYs. Results: SDS-BMI decreased in the first 6 months of treatment, stabilized in the second 6 months, and increased during the 2nd year in both groups. After 24 months, SDS-BMI was similar in both groups, but remained lower than baseline values (mean difference -0.24, 95% CI -0.42; -0.06). There was no difference in QALYs between the groups after 24 months. For SDS-BMI, the probability of the short-stay treatment being cost-effective in comparison with the long-stay treatment was 1 at a willingness-to-pay of 0 EUR/unit of effect, which slowly decreased to 0.54 for larger willingness-to-pay values. Conclusions: Based on the results of this study, the short-stay treatment is considered to be more cost-effective from the societal perspective in comparison with the long-stay treatment. Future research should provide insight in whether the short-stay treatment is cost-effective in comparison with usual care.

The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity A Mediation Analysis

Purpose: To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs. Design: Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1). Setting: A random sample of a Dutch online interview panel was obtained. Subjects: Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s). Measures: Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire. Analysis: Linear regression analysis. Results: The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs. Conclusion: Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle.

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results.

Cost-Effectiveness of Manual Therapy Versus Physical Therapy In Patients With Sub-Acute and Chronic Neck Pain: A Randomized Controlled Trial

Purpose To evaluate the cost-effectiveness of manual therapy according to the Utrecht School (MTU) in comparison with physiotherapy (PT) in sub-acute and chronic non-specific neck pain patients from a societal perspective.