bims-cieche 2025-09-21 papers

Issue of 2025–09–21
four papers selected by
Jonas Stefaan Steel, IDEWE

J Occup Rehabil. 2025 Sep 19.

Return on Investment of the Back At Work After Surgery (BAAS) Care Pathway Compared to Care-as-Usual in Knee Arthroplasty.

Daniël O Strijbos, A Carlien Straat, Geert van der Sluis, Wim F C van Houtert, Johanna M van Dongen, Tim Boymans, P Paul F M Kuijer, Michiel F Reneman.

PURPOSE: The Back At work After Surgery (BAAS) care pathway integrates medical and occupational care to enhance return to work (RTW) after knee arthroplasty (KA). BAAS has shown effectiveness in improving RTW outcomes, but its economic impact is unknown. This study evaluates the costs and return on investment (ROI) of BAAS compared with care-as-usual.
METHODS: This multicenter, prospective cohort study involved 270 employed patients having KA, comparing the BAAS pathway (n = 137) to care-as-usual (ACTIVE trial, n = 133). The ROI was evaluated from societal and employer's perspectives. Productivity (absenteeism and presenteeism) and healthcare (primary and secondary) costs were assessed using cost questionnaires administered at 3, 6, 9, and 12 months post-surgery. Propensity score matching and multiple imputation addressed non-randomization and missing data, respectively. ROI was calculated by dividing the netto benefits-defined as reductions in productivity and healthcare costs, or productivity costs alone minus costs of the BAAS intervention-by the intervention costs multiplied by 100%.
RESULTS: Propensity score-matched analyses included 102 patients per cohort. The total netto benefits from employers and societal perspective were of €4,493 and €4,982, respectively. Intervention costs were €845/patient. This resulted in a ROI of 590% (95% CI 67-1112%) and 532% (95% CI 27-1037%) from the societal and employer's perspective, respectively, per Euro invested.
CONCLUSIONS: The BAAS care pathway demonstrates a favorable economic impact through significant 12 month downstream reductions in absenteeism and healthcare costs, and a positive ROI from both the societal and employer perspective.
TRAIL REGISTRATION: This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).

Keywords: Arthrosis; Knee; Occupational medicine; Orthopedic procedures; Rehabilitation; Return on investment

DOI: https://doi.org/10.1007/s10926-025-10328-w

Appl Health Econ Health Policy. 2025 Sep 16.

A Systematic Review of Economic Evaluations on Interventions Targeting Insomnia or Hypersomnia.

Phuong Hong Le, Long Khanh-Dao Le, Dai Quy Le, Shantha M W Rajaratnam, Cathrine Mihalopoulos.

OBJECTIVE: Insomnia and hypersomnia are sleep conditions associated with significant costs to the healthcare system and society. This study aimed to review the cost-effectiveness evidence of interventions for insomnia and hypersomnia, including psychotherapy, pharmacotherapy, and complementary and alternative medicine (CAM), across the age spectrum.
METHODS: A systematic search (from inception to 18th February 2025) was conducted in electronic databases (Medline, PsycINFO, CINAHL, Econlit and Embase) and Health Technology Assessment websites. Full economic evaluations and return-on-investment analyses were included if they focused on treatments targeting insomnia or hypersomnia in people aged ≥12 years. The Drummond checklist was used to evaluate the quality of eligible studies. Narrative synthesis was applied to extract study characteristics and economic evaluation outcomes.
RESULTS: Twenty-eight studies met the pre-defined criteria, including 26 for adults and older adults with insomnia, two for adolescents with insomnia, and no studies were found for hypersomnia treatment. Cognitive behavioural therapy for insomnia (CBT-I) and pharmacotherapy were likely to be cost-effective interventions for insomnia compared to inactive controls. Digital CBT-I was found to generate healthcare and societal cost savings when compared to face-to-face CBT-I or pharmacotherapy. The cost-effectiveness of CAM interventions is under-researched and remains unclear.
CONCLUSION: Among insomnia interventions, CBT-I has the strongest cost-effectiveness credentials. Future studies should focus on hypersomnia, adolescent insomnia, and comorbid insomnia and related conditions.
PROSPERO REGISTRATION NUMBER: CRD42022343067.

DOI: https://doi.org/10.1007/s40258-025-00997-2

Neth Heart J. 2025 Sep 15.

Cardiovascular disease and absenteeism in Dutch occupational health: a retrospective study in a regular working population.

Ivo M van Dongen, Jobst Winter, Bart Aben, Gilbert W M Wijntjens, Ronak Delewi, Jan Siebers, Robin N Kok, Frederieke G Schaafsma.

BACKGROUND: There is very limited data available on the impact of cardiovascular disease (CVD) on absenteeism occurrence, absenteeism duration, and the associated rough cost-estimate for employers.
METHODS: We extracted routinely collected absenteeism data for the years 2019-2022 from a database maintained by two large, nationally operating occupational health services (n = 443,740). All diagnoses and included sickness cases were recorded > 6 weeks of absenteeism. Descriptive statistics, including median values (IQR) and percentages, were calculated and compared using the Mann-Whitney U test and Pearson chi-square test. Subgroup comparisons were performed using the Kruskal-Wallis test. To analyse return-to-work over time, a Kaplan-Meier curve was constructed, and differences in return-to-work were assessed using the Log Rank (Mantel-Cox) test.
RESULTS: CVD is the primary cause of absenteeism in 3.2% of all absenteeism cases. The median duration of absenteeism following CVD was 119 working days (IQR 156; Q1-Q3 62.9-218.6) with a minimum rough cost-estimate to employers of € 37,000 per employee. The most frequently occurring CVD diagnoses were: acute myocardial infarction, cerebrovascular disease, cardiac arrhythmia, unspecified cardiovascular complaints and angina.
CONCLUSIONS: CVD occurs frequently, results in prolonged absenteeism, and incurs high costs for employers. We strongly believe that CVD-related absenteeism should receive greater attention. Specifically, both in-hospital and outpatient treatments should place a stronger emphasis on work-related issues, including strategies for returning to work with or without tailored assignments in the workplace. This focus will help ensure that employees can sustainably return to work and continue to contribute to society.

Keywords: Absenteeism duration; Absenteeism-related costs; Cardiovascular disease; Sick leave

DOI: https://doi.org/10.1007/s12471-025-01989-6

Health Econ. 2025 Sep 15.

Do Stronger Employer Responsibilities Enhance Work Accommodation for Sick-Listed Workers? Evidence From a Dutch Reform.

Laura Jansen, Viola Angelini, Max Groneck, Raun van Ooijen.

This paper studies the impact of stronger employer responsibilities for facilitating work resumption of sick or disabled workers on employers' workplace accommodation efforts during sick leave. We exploit a reform in the Netherlands that altered experience rating-that is, shifting the costs of sick leave and disability insurance to the firm-both for permanent and non-permanent employees. Using unique Dutch survey data on workplace accommodation of long-term sick-listed workers, we show that experience rating has no significant impact on accommodation efforts. Moreover, we provide evidence that the reform led to more firms opting for self-arranging both the sick leave benefits and the reintegration process of sick non-permanent workers, instead of using the public insurance scheme.

Keywords: disability insurance; employer incentives; experience rating; workplace accommodation

DOI: https://doi.org/10.1002/hec.70038