Cost-effectiveness Of Early Versus Delayed Functional Restoration For Chronic Disabling Occupational Musculoskeletal Disorders

Abstract

Chronic pain is among the most costly disorders in the United States. Societal impacts include productivity losses, disability compensation, and reduction in psychosocial well-being. To date, there is little documentation on the effect of extended disability on both treatment- and cost-effectiveness. The present study investigated the treatment- and cost-effectiveness of early versus delayed functional restoration for three groups, in a matched cohort design based on length of disability: Early Rehabilitation (4-8 months); Intermediate Duration (9-18 months); and Delayed Rehabilitation (>18 months). Psychosocial deficits at pre-rehabilitation were significantly greater for the late rehabilitation groups, with approximately 2 times greater likelihood of Major Depressive Disorder and Opioid Dependence Disorder. At post-rehabilitation, all groups fared equally well on psychosocial measures, with no significant differences observed on one-year objective, socioeconomic outcomes (e.g., ≥ 85% RTW regardless of disability duration). Economic analyses indicated that early rehabilitation was a cost-effective approach to managing chronic disability, despite comparable outcomes across the disability duration groups. Costs during the timeframe of the rehabilitation program were significantly and positively associated with Major Depressive Disorder and prior surgeries. When accounting for the costs accrued over the duration of disability, early rehabilitation yields an estimated savings in costs up to 66%, or approximately $138,000 per patient. The findings in this study are consistent with the biopsychosocial paradigm for the etiology of disability, and are also supported by previous documentation on the efficacy and cost-effectiveness of treatment modalities incorporating the biopsychosocial model of managing pain and disability.