Cost-effectiveness of a multi-faceted workplace intervention to prevent and manage musculoskeletal pain in nursing staff: a cluster-randomized controlled trial (INTEVAL_Spain)

Abstract

Purpose To evaluate the cost-effectiveness of a multifaceted workplace intervention to prevent and manage musculoskeletal pain (MSP) in nursing staff. Methods The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALY). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALY were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALY were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed. Results Total mean costs were €367 and €154 for the intervention and control group, respectively. The intervention costs were €38/person. From the societal perspective, the ICER showed that overall additional €12 (€6 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €6 from the societal and €3 from the health system perspectives for neck, shoulders and upper back pain; €10 and €4 for low back; €33 and €14 for hands; €7 and €3for legs; €21 and €9 for the knees; and €7 and €3 for feet. The ICER was dominated by usual care in the elbows and QALY. Conclusion Although the efficiency of this intervention cannot be fully established, these findings are encouraging to reduce MSP in the workplace. Study registration: ISRCTN15780649, retrospectively registered.