Cindy Noben1, Filip Smit2, Karen Nieuwenhuijsen3, Sarah Ketelaar3, Fania Gärtner3, Brigitte Boon4, Judith Sluiter3, Silvia Evers5. 1. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands. Electronic address: c.noben@maastrichtuniversity.nl. 2. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, EMGO+ Institute of Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands. 3. Coronel Institute of Occupational and Environmental Health, Academic Medical Centre, Amsterdam, Netherlands. 4. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands. 5. Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands; Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
Abstract
BACKGROUND: The specific job demands of working in a hospital may place nurses at elevated risk for developing distress, anxiety and depression. Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning. OBJECTIVE: To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints. Three conditions were compared: the control condition consisted of online screening for mental health problems without feedback about the screening results. The occupational physician condition consisted of screening, feedback and referral to the occupational physician for screen-positive nurses. The third condition included screening, feedback, and referral to e-mental health. DESIGN: The study was designed as an economic evaluation alongside a pragmatic cluster randomised controlled trial with randomisation at hospital-ward level. SETTING AND PARTICIPANTS: The study included 617 nurses in one academic medical centre in the Netherlands. METHODS: Treatment response was defined as an improvement on the Nurses Work Functioning Questionnaire of at least 40% between baseline and follow-up. Total per-participant costs encompassed intervention costs, direct medical and non-medical costs, and indirect costs stemming from lost productivity due to absenteeism and presenteeism. All costs were indexed for the year 2011. RESULTS: At 6 months follow-up, significant improvement in work functioning occurred in 20%, 24% and 16% of the participating nurses in the control condition, the occupational physician condition and the e-mental health condition, respectively. In these conditions the total average annualised costs were €1752, €1266 and €1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of €5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health condition versus the control condition was estimated at €4054 (added costs) per treatment responder. Sensitivity analyses attested to the robustness of these findings. CONCLUSIONS: The occupational physician condition resulted in greater treatment responses for less costs relative to the control condition and can therefore be recommended. The e-mental health condition produced less treatment response than the control condition and cannot be recommended as an intervention to improve work functioning among nurses.
RCT Entities:
BACKGROUND: The specific job demands of working in a hospital may place nurses at elevated risk for developing distress, anxiety and depression. Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning. OBJECTIVE: To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints. Three conditions were compared: the control condition consisted of online screening for mental health problems without feedback about the screening results. The occupational physician condition consisted of screening, feedback and referral to the occupational physician for screen-positive nurses. The third condition included screening, feedback, and referral to e-mental health. DESIGN: The study was designed as an economic evaluation alongside a pragmatic cluster randomised controlled trial with randomisation at hospital-ward level. SETTING AND PARTICIPANTS: The study included 617 nurses in one academic medical centre in the Netherlands. METHODS: Treatment response was defined as an improvement on the Nurses Work Functioning Questionnaire of at least 40% between baseline and follow-up. Total per-participant costs encompassed intervention costs, direct medical and non-medical costs, and indirect costs stemming from lost productivity due to absenteeism and presenteeism. All costs were indexed for the year 2011. RESULTS: At 6 months follow-up, significant improvement in work functioning occurred in 20%, 24% and 16% of the participating nurses in the control condition, the occupational physician condition and the e-mental health condition, respectively. In these conditions the total average annualised costs were €1752, €1266 and €1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of €5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health condition versus the control condition was estimated at €4054 (added costs) per treatment responder. Sensitivity analyses attested to the robustness of these findings. CONCLUSIONS: The occupational physician condition resulted in greater treatment responses for less costs relative to the control condition and can therefore be recommended. The e-mental health condition produced less treatment response than the control condition and cannot be recommended as an intervention to improve work functioning among nurses.
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