Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial.

BACKGROUND: Although evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands. METHODS: Three hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses. RESULTS: The cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY). CONCLUSIONS: The SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken. TRIAL REGISTRATION: The SLIMMER study is retrospectively registered with ClinicalTrials.gov (Identifier NCT02094911) since March 19, 2014.

Effect evaluation of a two-year complex intervention to reduce loneliness in non-institutionalised elderly Dutch people.

BACKGROUND: Public health policy calls for intervention programmes to reduce loneliness in the ageing population. So far, numerous loneliness interventions have been developed, with effectiveness demonstrated for few of these interventions. The loneliness intervention described in this manuscript distinguishes itself from others by including multiple intervention components and targeting individuals and their environment. Intervention components included a mass media campaign, information meetings, psychosocial group courses, social activities organised by neighbours, and training of intermediaries. The aim of this manuscript is to study the effects of this integrated approach on initial and long-term outcomes. METHODS: A quasi-experimental pre-test post-test intervention study was conducted among non-institutionalised elderly people aged 65 years and over to evaluate the effectiveness of the intervention by comparing the intervention community and the control community. Data on outputs, initial and long-term outcomes, and the overall goal were collected by self-administered questionnaires. Data of 858 elderly people were available for the analyses. To assess the effect linear regression analyses with adjustments for age, gender, church attendance, and mental health were used. In addition, the process evaluation provided information about the reach of the intervention components. RESULTS: After two years, 39% of the elderly people were familiar with the intervention programme. The intervention group scored more favourably than the control group on three subscales of the initial outcome, motivation (-4.4%, 95% CI-8.3--0.7), perceived social support (-8.2%, 95% CI-13.6--2.4), and subjective norm (-11.5%, 95% CI-17.4--5.4). However, no overall effects were observed for the long-term outcome, social support, and overall goal, loneliness. CONCLUSIONS: Two years after its initiation the reach of the intervention programme was modest. Though no effect of the complex intervention was found on social support and loneliness, more favourable scores on loneliness literacy subscales were induced.

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

BACKGROUND: The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. METHODS: The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. RESULTS: The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. CONCLUSIONS: In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement. TRIAL REGISTRATION NUMBER: NTR1117.

Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: a cluster randomised controlled trial in an occupational setting.

BACKGROUND: Arm, shoulder and neck symptoms are very prevalent among computer workers. In an attempt to reduce these symptoms, a large occupational health service in the Netherlands developed a preventive programme on exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and sick leave in computer workers. The purpose of this study was to assess the effectiveness of this intervention programme. METHODS: The study was a randomised controlled trial. The participants were assigned to either the intervention group or the usual care group by means of cluster randomisation. At baseline and after 12 months of follow-up, the participants completed the RSI QuickScan questionnaire on exposure to the risk factors and on the prevalence of arm, shoulder and neck symptoms. A tailor-made intervention programme was proposed to participants with a high risk profile at baseline. Examples of implemented interventions are an individual workstation check, a visit to the occupational health physician and an education programme on the prevention of arm, shoulder and neck symptoms. The primary outcome measure was the prevalence of arm, shoulder and neck symptoms. Secondary outcome measures were the scores on risk factors for arm, shoulder and neck symptoms and the number of days of sick leave. Sick leave data was obtained from the companies. Multilevel analyses were used to test the effectiveness. RESULTS: Of the 1,673 persons invited to participate in the study, 1,183 persons (71%) completed the baseline questionnaire and 741 persons participated at baseline as well as at 12-month follow-up. At 12-month follow-up, the intervention group showed a significant positive change (OR = 0.48) in receiving information on healthy computer use, as well as a significant positive change regarding risk indicators for work posture and movement, compared to the usual care group. There were no significant differences in changes in the prevalence of arm, shoulder and neck symptoms or sick leave between the intervention and usual care group. CONCLUSIONS: The effects of the RSI QuickScan intervention programme were small, possibly as a result of difficulties with the implementation process of the proposed interventions. However, some significant positive effects were found as to an increase in receiving education and a decrease in exposure to adverse postures and movements. With regard to symptoms and sick leave, only small and non-significant effects were found. TRIAL REGISTRATION: Netherlands National Trial Register NTR1117.

Effectiveness of physical training for self-employed persons with musculoskeletal disorders: a randomized controlled trial.

BACKGROUND: Despite the fact that the population of self-employed persons is still growing and at risk for long term disability due to a number of risk factors, there is still a lack of information on the effectiveness of interventions for this specific group. METHODS: To determine the effectiveness of physical training without a cognitive behavioral component and workplace specific exercises (PT) and physical training with a cognitive behavioral component and workplace specific exercises (PTCBWE), we conducted a pragmatic Randomized Controlled Trial, stratified into two groups. Self-employed persons with a new work disability claim because of musculoskeletal disorders were randomized to PT (n = 53) or PTCBWE (n = 76), or to a corresponding usual care group (n = 50 and n = 75 respectively). Both types of training consisted of cardiovascular training, strengthening, relaxation and posture exercises and took place two or three times a week, for 1-1.5 hours, during three months, also if someone had already returned to work full-time. The primary outcome measure was claim duration (in days) during 12 months follow-up. Pain severity and functional status were secondary outcome measures. All data were assessed at baseline and at 6 and 12 months follow-up. The data with regard to claim duration were analyzed by survival analysis and Cox regression analysis. Secondary outcome measures were analyzed by means of linear regression analysis. RESULTS: After 12 months of follow-up there was no difference in claim duration between PT and usual care (Hazard Ratio 0.7; 95%CI, 0.4-1.1; p = 0.12) or PTCBWE and usual care (Hazard Ratio 0.9; 95%CI, 0.6-1.4; p = 0.72). Both types of physical training and usual care improved in pain and functional status over time, but there was only a statistically significant difference in favor of PT on pain improvement at 6 months. CONCLUSION: In this study, physical training with and without a cognitive behavioral component and workplace specific exercises for self-employed persons with musculoskeletal disorders was not shown to be effective on claim duration, pain severity and functional status at 12 months follow-up. TRIAL REGISTRATION: Current Controlled Trials ISRCTN67766245.

The feasibility of a web-based counselling program for occupational physicians and employees on sick leave due to back or neck pain.

BACKGROUND: The objective of this feasibility study was to gain insight into occupational physicians' (OPs) and employees' use of, and attitudes towards, 'Snelbeter' (Get Well Fast), a new web-based counselling program for employees on sick leave due to non-specific back or neck pain and their OPs. METHODS: Registered user information was collected from the website to get insight in the use of the program by employees (n = 24). Qualitative information was obtained through semi-structured in-depth interviews with 19 OPs and nine employees in order to get insight in the actual use of the provided information, the attitudes towards the program and possible improvements of the program. RESULTS: Actual use of the program among OPs was low. The majority of OPs, eight out of 11 (73%), never or only occasionally signed in. The greatest obstacle for OPs to use the program was the low number of eligible employees involved. Employees appreciated the program but their use was moderate. A small majority of the employees who used the program, 14 out of 24 (58%), opened 50% to 100% of the provided documents, a majority of the interviewed employees, seven out of nine (78%), used the provided information sometimes or regularly. The absence of personal contact was found to be a major barrier towards use of the program by employees. CONCLUSION: Although both OPs and employees appreciated the idea of the program and employees appreciated using it, program utilization was moderate to low. The discussion section reveals that before implementation can be started to any extent, the program will need adaptations that make it more attractive to use. The program should be considered for both return to work (RTW) and the prevention of sick leave. Adding personal contact (e.g. involving physiotherapists) to the program may also be promising.

Risk factors for sickness absence because of low back pain among scaffolders: a 3-year follow-up study.

STUDY DESIGN: A prospective cohort study was conducted. OBJECTIVE: To find risk factors for short-term (14 days) sickness absence because of low back pain among scaffolders. SUMMARY OF BACKGROUND DATA: Although some studies have described the relation between work-related risk factors for musculoskeletal disease and sickness absence, little is known about the role of individual, physical, and psychosocial factors and different end points of low back pain as risk factors for sickness absence among scaffolders. METHODS: Between 1998 and 2001, 222 scaffolders and 66 supervisors (response rate, 86%) completed a questionnaire at baseline. In addition, data on sickness absence were collected from absence records. RESULTS: At baseline, 60% of the study population had experienced an episode of low back pain in the 12 months preceding the investigation, 37% of which were of chronic nature. During the follow-up period, 34% of the population had been on sick leave for at least one episode of low back pain. The risk factors for sickness absence less than 2 weeks were a high physical load from strenuous arm movements and severe low back pain. Workers with severe low back pain were at higher risk for sickness absence longer than 2 weeks. Psychosocial workload and individual characteristics did not predict the occurrence of sickness absence because of low back pain. CONCLUSIONS: Because work-related physical load was a risk factor for sickness absence less than 2 weeks and severe low back pain was a risk factor for sickness absence both shorter than and longer than 2 weeks, a focus on secondary prevention for scaffolders with severe low back pain is advised.