TY - JOUR
T1 - Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders
AU - Theodore, Brian R.
AU - Mayer, Tom G.
AU - Gatchel, Robert J.
N1 - Publisher Copyright:
© 2014, Springer Science+Business Media New York.
PY - 2015/6/22
Y1 - 2015/6/22
N2 - Purpose Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. Methods A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4–8 months of disability, N = 373), intermediate duration (ID: 9–18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. Results At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88 %), work retention (overall 80 %), and additional healthcare utilization (overall, 2.2 % of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64 % in medical costs, and up to 80 % in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56 % lower when administered early. Overall, ER resulted in estimated cost savings of up to 72 % (or almost $170,000 per claim). Conclusions Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of “last resort”.
AB - Purpose Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. Methods A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4–8 months of disability, N = 373), intermediate duration (ID: 9–18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. Results At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88 %), work retention (overall 80 %), and additional healthcare utilization (overall, 2.2 % of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64 % in medical costs, and up to 80 % in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56 % lower when administered early. Overall, ER resulted in estimated cost savings of up to 72 % (or almost $170,000 per claim). Conclusions Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of “last resort”.
KW - Chronic pain
KW - Cost-effectiveness analysis
KW - Disability
KW - Functional restoration
KW - Musculoskeletal disorders
KW - Socioeconomic outcomes
UR - http://www.scopus.com/inward/record.url?scp=84929398827&partnerID=8YFLogxK
U2 - 10.1007/s10926-014-9539-0
DO - 10.1007/s10926-014-9539-0
M3 - Article
C2 - 25194706
AN - SCOPUS:84929398827
SN - 1053-0487
VL - 25
SP - 303
EP - 315
JO - Journal of Occupational Rehabilitation
JF - Journal of Occupational Rehabilitation
IS - 2
M1 - 6
ER -