Budget impact analysis of a return-to-work intervention for cancer patients

Background: Published literature shows that return-to-work interventions
effectively support cancer survivors to resume work and potentially increase quality of life. However, return-to-work is currently not, or only partly (i.e. exercise test), reimbursed by health insurers. To ensure optimal support for cancer patients in resuming work, it is essential that hospitals can offer return-to-work in a financially viable way. The study 1) analyses the budget impact of a return-to-work intervention consisting of counselling by occupational physicians and a physical exercise programme; 2) explores how financing of a return-to-work intervention can be arranged.

Methods: A budget impact analysis was performed, comparing costs of return-to-work support for all patients able and willing to resume work versus no standardised support. All costs and financial benefits relevant from a societal perspective were considered, including intervention costs 4(based on the intervention protocol), productivity losses, social security, unemployment benefits, and patients’ costs (based on literature data), and presented for a hypothetical hospital serving a population of 200,000 patients. We identified which stakeholders, including hospitals, employers, health insurances, social security, and patients accrue what costs; and which enjoy the financial benefits under different financing arrangements.

Results: Based on the return-to-work protocol, costs for the intervention are approx. €2,000 per patient. For a hypothetical hospital with 570 cancer patients a year of which 100 patients are eligible and willing to take part, this will result in yearly costs of €193,800. Physical exercise costs as part of the intervention, approx. €1,300 per patient, are in most cases covered by health insurance, leaving €67,800 to be financed by the hospital. Even small improvements in return-to-work and quality of life led to substantial reductions in productivity loss, need for social benefits, and future health care costs. These savings outweigh the costs of the intervention, rendering return-to-work cost-saving from a societal perspective. Several feasible options for distributing costs and benefits among stakeholders are identified.

Conclusion: From a societal perspective, return-to-work is expected to be cost-saving. Hospitals bear approx. €67,800 intervention costs annually (hypothetical hospital, assuming a population of 200,000 patients), while most financial benefits fall upon other stakeholders. Re-distributing costs and financial benefits among stakeholders would result in feasible financing of the intervention.