[Return to Work after Mental Disorders - A Scoping Review]

The cost-utility of a return-to-work intervention in comparison to routine care for patients with mental disorders in Germany: Results from the RETURN project

BACKGROUND

Only two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU).

METHODS

We used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU.

RESULTS

No significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU.

CONCLUSIONS

The employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.

[Return to work of employees after a mental disorder]

Objectives

Returning to work often fails due to conflicting expectations and goals of the stakeholders involved. Due to their medical expertise and workplace-related knowledge, occupational physicians could effectively promote mutual understanding and cooperation between the stakeholders. The study aimed to develop a manual and training session for its application that will support occupational physicians to assume a mediating role in the integration of employees with a mental illness.

Methods

Based on a literature review and extensive qualitative preliminary work on the expectations of the stakeholders, the manual and training materials were developed, discussed and revised in several consecutive steps based on a participatory approach with occupational physicians and other experts. Finally, occupational physicians were trained to use the manual during their specialization training in order to subsequently test its practicability in everyday work.

Results

The manual presents information on the potentially different expectations of the actors for the return process and offers comprehensive advice for the mediating work of the occupational physicians. After a manualized training of approximately 2h, 9 out of 37 participants used the manual for return interviews within 4 months and 6 out of 9 rated it as helpful.

Conclusion

The first positive experiences of using the material developed with the target group justify a larger interventional study to investigate the presumed beneficial effects on the success of reintegration.