Comparative cost-effectiveness of two interventions to promote work functioning by targeting mental health complaints among nurses: pragmatic cluster randomised trial

C. Noben, F. Smit, K. Nieuwenhuijsen, S. Ketelaar, F. Gärtner, B. Boon, J. Sluiter, S. Evers

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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 euro1752, euro1266 and euro1375 per nurse. The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant, suggesting cost savings of euro5049 per treatment responder. The incremental cost-effectiveness ratio for the e-mental health condition versus the control condition was estimated at euro4054 (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.
Original languageEnglish
Pages (from-to)1321-1331
Number of pages11
JournalInternational Journal of Nursing Studies
Issue number10
Publication statusPublished - Oct 2014


  • Cost effectiveness
  • Mental disorders
  • Nurses
  • Occupational health
  • Prevention and control
  • Randomised controlled trial
  • Stress
  • Work functioning

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