Journal of Occupational Rehabilitation

, Volume 16, Issue 4, pp 557–578 | Cite as

Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain

  • Ivan A. Steenstra
  • Johannes R. Anema
  • Maurits W. van Tulder
  • Paulien M. Bongers
  • Henrica C. W. de Vet
  • Willem van MechelenEmail author
Original Paper


Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [−74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[−89.4, −2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.


Low back pain Operant behavioural Participative Ergonomics Return to work Randomized Controlled Trial Cost-effectiveness Occupational health 



We would like to thank all professionals at the OHSs for their cooperation in this study, Fieke Koopman for her excellent work in data collection and processing and Ernest de Vroome from TNO Work and Employment for building the syntax to calculate all sick leave outcomes.


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Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Ivan A. Steenstra
    • 1
    • 2
    • 3
    • 4
    • 6
  • Johannes R. Anema
    • 1
    • 2
    • 3
    • 4
  • Maurits W. van Tulder
    • 1
    • 5
  • Paulien M. Bongers
    • 1
    • 3
    • 4
  • Henrica C. W. de Vet
    • 1
  • Willem van Mechelen
    • 1
    • 2
    • 4
    Email author
  1. 1.Institute for Research in Extramural MedicineVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Public and Occupational HealthVU University Medical CenterAmsterdamThe Netherlands
  3. 3.TNO Work and EmploymentHoofddorpThe Netherlands
  4. 4.Body@WorkResearch Center Physical Activity, Work and Health, TNO-VUAmsterdamThe Netherlands
  5. 5.Institute for Health SciencesVU UniversityAmsterdamThe Netherlands
  6. 6.Institute for Work and HealthTorontoCanada

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