THU0670 A reumatologist's evaluation of how efficiencies in the management of painful lumbar syndrome in work disability creates benefits & savings

Abstract

Background: Musculoskeletal disorders are the most important cause of sick leave in the world.1 Lumbar pain is the main cause of temporary incapacity whith significant socio-economic impact. Objectives: Test efficiency of Healthcare approach by rheumatologist as savings in indirect costs e.g days off work and in direct costs derived from medical assistance in controlled patient group on sick leave diagnosed with lumbar pain. Methods: 2 year quasi-experimental bi-directional analytical design trial. Retrospective cohort in Control Group- CG and prospective cohort for intervention group -IG. Two groups, IG and CG respectively contain 150 (56% women aged 47.5 years±10) and 172 (48.8% women aged 44.2 years±10) working age patients with lumbar pain. Study made by Program for the Management of Temporary Disability implemented by Rheumatology Service of University Hospital of the Canary Islands. Study included early intervention, protocol in diagnostic tests and treatment. This study was evaluated by the Ethics Committee of the research of the University Hospital of Canary Islands fulfilling the requirements of suitability. Results: 24% of patients of IG fit to return to work after first appointment. Maximum efficiency of study between 30thand 45th day of sick leave. At 45 days 8% IG and 18,6% CG remained on sick leave. Average reduction 26 days of sick leave respect to CG, a total saving of 6.182 days of sick leave over 1 year, with efficiency of 62,2%. Saving in direct costs in IG over CG: medicaments, complementary tests, inter-consultations, follow up 48%. Absolute saving of 38.891C=, or equivalent 256.680C= for 1.000 patients. National Institute of Social Security Indirect sick leave costs 67,1%. Absolute saving of 129.883C=, or equivalent of 857.227C= for 1.000 patients. Indirect costs savings for Employers for intervention 50%. Absolute saving 108.649C=, or equivalent to 717.083C= for 1.000 patients. Workers in program saved 50% in salary loss. Average saving 605C= /worker. Total saved by implementation of program to State, to worker, to Employer- 360.142C=. Program Cost effective, producing average annual saving per patient of 259C= and average reduction of sick leave days of 41,2. Program cost efficiencies produced. Every day of disability saved equivalent to implementation cost of 5,06C=. Cost-benefit program produced for State saving of 6,44C= for every C= invested in implementation 137.248C=. Program had 93,8% patient acceptance expressing maximum satisfaction. Conclusions: Management of disability by rheumatologist highly profitable given low program implementation cost compared to savings generated for State and Employer.