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4. The Cost-Effectiveness and Return-On-Investment of a Combined Social and Physical Environmental Intervention in Office Employees

Author

van Dongen, J. M., Coffeng, J. K., van Wier, M. F., Boot, C. R. L., Hendriksen, I. J. M., van Mechelen, W., Bongers, P. M., van der Beek, A. J., Bosmans, J. E., and van Tulder, M. W.

Abstract

This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92), social environmental intervention (n = 118), physical environmental intervention (n = 96), or control group (n = 106). The social environmental intervention consisted of group motivational interviewing and the physical environmental intervention of workplace modifications. Both interventions were aimed at improving physical activity and relaxation. Effects included need for recovery (NFR), general vitality and job satisfaction. Cost-effectiveness analyses were performed from the societal and employer's perspective, and return-on-investment analyses from the employer's perspective. Compared with usual practice, the combined intervention was significantly more effective in improving NFR (-8.4;95% CI:-14.6;-2.2) and significantly more expensive to the employer (3102; 95%CI:598;5969). All other between-group differences were non-significant. For NFR, the combined intervention became the preferred option at willingness-to-pays of =€170/point improvement (society) and =€300/point improvement (employer). For general vitality and job satisfaction, the interventions' maximum probabilities of cost-effective were low (=0.55). All interventions had a negative return-on-investment. The combined intervention may be cost-effective for NFR depending on the decision-makers' willingness-to-pay. Both separate interventions are not cost-effective for NFR. All interventions were neither cost-effective for general vitality and job satisfaction, nor cost-saving to the employer.

Published
2017
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27. Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome

Author

Van Gerven, P., Van Dongen, J. M., Rubinstein, S. M., Termaat, M. F., El Moumni, M., Zuidema, W. P., Krijnen, P., Schipper, I. B., Van Tulder, M. W., Van Bodegom-Vos, L., Breederveld, R. S., Derksen, R. J., Van Dijkman, B., Goslings, J. C., Hegeman, J. H., Hoogendoorn, J. M., Van Kuijk, C., Meylaerts, S. A.G., Rosendaal, F. R., Weil, N. L., Wendt, K. W., Health Economics and Health Technology Assessment, Amsterdam Movement Sciences, APH - Health Behaviors & Chronic Diseases, APH - Methodology, Faculty of Behavioural and Movement Sciences, APH - Societal Participation & Health, Biomedical Signals and Systems, Surgery, VU University medical center, Epidemiology and Data Science, Other Research, Radiology and nuclear medicine, and APH - Quality of Care

Subjects
Adult, Male, medicine.medical_specialty, Radiography, Cost-Benefit Analysis, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Cost Savings, Medicine, Humans, EPIDEMIOLOGY, Routine, 030212 general & internal medicine, Aged, Netherlands, Ankle fractures, Randomised controlled trial, UTILITY, 030222 orthopedics, business.industry, lcsh:Public aspects of medicine, Health Policy, Medical record, Cost-effectiveness analysis, Follow-up, lcsh:RA1-1270, Middle Aged, Missing data, Economic evaluation, LIFE, medicine.anatomical_structure, Treatment Outcome, Physical therapy, Female, Ankle, business, Research Article
Abstract

Background To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures. Methods We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping. Results In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was − 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (−€48; 95% CI:- €72 to -€25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of €20,000 per QALY. Conclusions Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs. Trial registration The trial was registered on 26-05-2014 in the Netherlands Trial Registry, with reference number NL4477 (www.trialregister.nl/trial/4477).

Published
2020
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28. DEVELOPMENT AND INTERNAL VALIDATION OF A CLINICAL PREDICTION MODEL FOR NON-RECOVERY IN OLDER ADULTS WITH BACK PAIN

Author

van der Gaag, W. H., Chiarotto, A., Heymans, M. W., Enthoven, W. T., Luijsterburg, P. A., van Rirsel-Scheele, J., Bohnen, A. M., van Tulder, M. W., Bierma-Zeinstra, S. M., Koes, B. W., Health Economics and Health Technology Assessment, AMS - Ageing and Morbidity, APH - Methodology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, and APH - Societal Participation & Health

Published
2020

40. DEALING WITH MISSING DATA IN TRIAL-BASED ECONOMIC EVALUATIONS: A METHODOLOGICAL SCOPING REVIEW

Author

Guevara Morel, A., Varga, A., El Alili, M., van Schaik, D., van Tulder, M. W., van Dongen, H., Bosmans, J., Health Economics and Health Technology Assessment, APH - Methodology, Faculty of Behavioural and Movement Sciences, APH - Societal Participation & Health, AMS - Ageing and Morbidity, AMS - Sports and Work, APH - Mental Health, and APH - Aging & Later Life

Published
2019

45. COMPARING THE EQ-5D-5L CROSSWALKS AND VALUE SETS FOR ENGLAND, THE NETHERLANDS AND SPAIN: DO CONCLUSIONS CHANGE?

Author

Ben, A., Finch, A. P., van Dongen, J. M., Wit, Md, van Dijk, S. E., Adriaanse, M. C., Snoek, F. J., van Tulder, M. W., Bosmans, J. E., Health Economics and Health Technology Assessment, APH - Health Behaviors & Chronic Diseases, Health Sciences, AMS - Ageing and Morbidity, AMS - Sports and Work, APH - Methodology, APH - Societal Participation & Health, and APH - Mental Health

Published
2018

47. 'Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses': Update 2018

Author

Huygen, F.J.P.M. (Frank), Kallewaard, J.W., van Tulder, M., Van Boxem, K., Vissers, K., Kleef, M. (Maarten) van, Zundert, J., Huygen, F.J.P.M. (Frank), Kallewaard, J.W., van Tulder, M., Van Boxem, K., Vissers, K., Kleef, M. (Maarten) van, and Zundert, J.

Abstract

Introduction: Between 2009 and 2011 a series of 26 articles on evidence-based medicine for interventional pain medicine according to clinical diagnoses were published. The high number of publications since the last literature search justified an update. Methods: For the update an independent 3rd party, specialized in systematic reviews was asked in 2015 to perform the literature search and summarize relevant evidence using Cochrane and GRADE methodology to compile guidelines on interventional pain management. The guideline committee reviewed the information and made a last update on March 1st 2018. The information from new studies published after the research performed by the 3th party and additional observational studies was used to incorporate other factors such as side effects and complications, invasiveness, costs and ethical factors, which influence the ultimate recommendations. Results: For the different indications a total of 113 interventions were evaluated. Twenty-seven (24%) interventions were new compared to the previous guidelines and the recommendation changed for only 3 (2.6%) of the interventions. Discussion: This article summarizes the evolution of the quality of evidence and the strength of recommendations for the interventional pain treatment options for 28 clinical pain diagnoses. &

Published
2019
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49. Omitting Routine Radiography of Traumatic Distal Radial Fractures After Initial 2-Week Follow-up Does Not Affect Outcomes

Author

van Gerven, P, El Moumni, M, Zuidema, W P, Rubinstein, S M, Krijnen, P, van Tulder, M W, Schipper, I B, Termaat, M F, van Gerven, P, El Moumni, M, Zuidema, W P, Rubinstein, S M, Krijnen, P, van Tulder, M W, Schipper, I B, and Termaat, M F

Abstract

BACKGROUND: Routine radiography in the follow-up of distal radial fractures is common practice, although its usefulness is disputed. The aim of this study was to determine whether the number of radiographs in the follow-up period can be reduced without resulting in worse patient outcomes.METHODS: In this multicenter, prospective, randomized controlled trial with a non-inferiority design, patients ≥18 years old with a distal radial fracture could participate. They were randomized between a regimen with routine radiographs at 6 and 12 weeks of follow-up (usual care) and a regimen without routine radiographs at those time points (reduced imaging). Randomization was performed using an online registration and randomization program. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist/Hand Evaluation (PRWHE) score, health-related quality of life, pain, and complications. Outcomes were assessed at baseline and after 6 weeks, 3 months, 6 months, and 1 year of follow-up. Data were analyzed using mixed models. Neither the patients nor the health-care providers were blinded.RESULTS: Three hundred and eighty-six patients were randomized, and 326 of them were ultimately included in the analysis. The DASH scores were comparable between the usual-care group (n = 166) and the reduced-imaging group (n = 160) at all time points as well as overall. The adjusted regression coefficient for the DASH scores was 1.5 (95% confidence interval [CI] = -1.8 to 4.8). There was also no difference between the groups with respect to the overall PRWHE score (adjusted regression coefficient, 1.4 [95% CI = -2.4 to 5.2]), quality of life as measured with the EuroQol-5 Dimensions (EQ-5D) (-0.02 [95% CI = -0.05 to 0.01]), pain at rest as measured with a visual analog scale (VAS) (0.1 [95% CI = -0.2 to 0.5]), or pain when moving (0.3 [95% CI = -0.1 to 0.8]). The complication rate was similar in the reduced

Published
2019
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