Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis

J Occup Health. 2017 May 25;59(3):267-279. doi: 10.1539/joh.16-0082-OA. Epub 2017 Apr 5.


Objectives: Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity.

Methods: Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings.

Results: At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings.

Discussion: The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.

Keywords: Cost effectiveness; Integrated care; Occupational Health; Participatory workplace intervention; Productivity; Rheumatoid arthritis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Absenteeism
  • Adolescent
  • Adult
  • Arthritis, Rheumatoid / economics*
  • Arthritis, Rheumatoid / therapy*
  • Cost-Benefit Analysis
  • Efficiency*
  • Efficiency, Organizational / economics*
  • Female
  • Humans
  • Intention to Treat Analysis
  • Male
  • Middle Aged
  • Netherlands
  • Occupational Health / economics*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires
  • Young Adult