M.F. van Wier

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.

Cost-effectiveness of a distance lifestyle counselling programme among overweight employees from a company perspective, ALIFE@Work: A randomized controlled trial

OBJECTIVE The objective of this study was to determine whether a lifestyle intervention with individual counselling was cost-effective for reducing body weight compared with usual care from a company perspective. PARTICIPANTS Overweight employees were recruited and randomly assigned to the intervention groups, either phone or Internet, or the control group. METHODS The intervention was based on a cognitive behavioural approach and addressed physical activity and diet. Self-reported body weight was collected at baseline and 12 months follow-up. Intervention costs and costs of sick leave days based on gross and net lost productivity days (GLPDs/NLPDs) obtained from the participating companies were calculated. Missing data were imputed using multiple imputation techniques. Uncertainty surrounding the differences in costs and the incremental cost-effectiveness ratios (ICER) was estimated by bootstrapping techniques, and presented on cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS No statistically significant differences in total costs were found between the intervention groups and control group, though mean total costs in both intervention groups tended to be higher than those in the control group. The ICER of the Internet group compared with the control group was €59 per kilogram of weight loss based on GLPD costs. The probability of cost effectiveness of the Internet intervention was 45% at a willingness-to-pay of €0 per extra kilogram weight loss and 75% at a willingness-to-pay of €1500 per extra kilogram body weight loss. Comparable results were found for the phone intervention. CONCLUSIONS The intervention was not cost effective in comparison with usual care from the company perspective. Due to the large amount of missing data, it is not possible to draw firm conclusions.

Economic evaluation of an occupational health care guideline for prevention of weight gain among employees.

Objective:To determine the cost-effectiveness and the financial return of a guideline for occupational physicians (OPs), aimed at the prevention of weight gain among employees. Methods:The guideline consisted of a company-environment scan and up to five individual sessions with an OP. Sixteen OPs randomized to the guideline (n = 7) or usual care group (n = 9) recruited 275 and 249 employees. Costs were collected by using 3-monthly retrospective questionnaires. Quality-adjusted life-years gained were determined with 6-monthly administered EuroQol-5D. Waist circumference and body weight were measured at baseline and 18 months. Results:Unfavorable differences were found on waist circumference (+1.6 cm; 95% confidence interval [CI], 0.27 to 2.90) and weight (+1.1 kg; 95% CI, 0.01 to 2.15). Probabilities of cost-effectiveness were consistently less than 55%. Net employer loss was &OV0556;−158 (95% CI, −2865 to 2672). Conclusions:The occupational health care guideline was not cost-effective and no financial return was shown.