The cost effectiveness of NHS physiotherapy support for occupational health (OH) services

Abstract

Background: Musculoskeletal pain is detrimental to quality of life (QOL) and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG) established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP) comprising: 1.) telephone advice and triage, 2.) face-to-face physiotherapy assessment and treatment if required, and 3.) workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. Methods: A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY) was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. Results: A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3%) and 199 (40.9%) were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the health gains contributed to a cost/QALY of £1386-£7760, which would represent value for money according to current UK thresholds. Sensitivity analyses demonstrated that the service would remain cost effective until the service costs were increased to 160% per user. Conclusions: This pragmatic evaluation of the OHPPP indicated that it was likely to be feasible in terms of service usage and could potentially be cost effective in terms of QALYs. Further, the study confirmed that improving physical health status for musculoskeletal pain patients is important in reducing problems with work capacity and related costs. This study suggests that this type of service could be potentially be useful in reducing the burden of pain and should be further investigated, ideally via randomised controlled trials assessing effectiveness and costeffectiveness.

Assessing the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory

“…Regarding the influence of pain on work, we emphasize the importance of the physiotherapist’s role. According to Phillips et al 19 ) , a physiotherapeutic program for improving the physical health status of patients with pain significantly helps reduce work-related problems and costs. Thus, any physiotherapeutic approach first requires a complete patient history that identifies labor activities and activities of daily living to establish effective interventions that promote physical autonomy.…”

Productivity estimation in economic evaluations of occupational health and safety interventions: a systematic review

“…Measure for reduced productivity at work/ while working 31 (39, 41-44, 56, 60-65, 69, 70, 72, 77, 82, 87, 89, 94, 95, 98, 103, 104, 114, 115, 118, 119, 123, 124, 128) Source presenteeism Employee survey 18 (41, 44,56,62,64,69,72,82,87,89,94,95,98,104,115,118,119, 123) Simulated / assumptions 7 (39, 43, 44,103,114,124, 128) Previous studies 6 (42,60,61,63,65,70) Firm data 1 (115) Employer survey 1 (77) Survey/instrument presenteeism 56,62,69,82,94,95,118,119,123) Days (unspecified) 49 (39, 40, 42, 46,49,(51)(52)(53)(54)58,60,62,64,66,71,72,74,75,(77)(78)…”

Experiences of occupational health doctors and nurses about the role of physiotherapists in occupational health rehabilitation: A qualitative study

“…Phillips et al evaluated the cost-e®ectiveness of physiotherapy support for NHS occupational health services and found that physiotherapists were not only skilled to deal with a range of musculoskeletal disorders of the back, neck and upper and lower limbs, but this service had a cost bene¯t which represents value for money. 11 Occupational health doctors and nurses also reported challenges that physiotherapists may experience when providing occupational health rehabilitation. Participants viewed the occupational health department as a complex working environment that is in°uenced not only by clinical care, but by demanding occupational health challenges and organizational changes.…”