Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): a cost-effectiveness analysis comparing team-based rehabilitation in primary care vs treatment as usual.

TL;DR: An RCT comparing structured team-based rehabilitation in primary care to standard treatment for musculoskeletal pain found no meaningful difference in health outcomes or total societal costs over one year, with cost-effectiveness probability hovering around 50% at conventional thresholds.

What the study found

The PREVSAM trial investigated whether a coordinated, team-based rehabilitation approach in primary care could improve outcomes and reduce costs for patients at high risk of work absence due to musculoskeletal pain. Researchers screened patients using the Örebro Musculoskeletal Pain Screening Questionnaire (short form) and enrolled those scoring 40 or higher, indicating elevated risk for prolonged sickness absence.

The intervention group received team-based rehabilitation coordinated across primary care, while the control group received standard treatment as usual. Over 12 months, both groups showed similar improvements in quality-adjusted life-years (QALYs), the standard metric for health-related quality of life. From a healthcare system perspective, the structured PREVSAM model cost more money: the higher costs of rehabilitation services were not offset by reductions in other primary care visits, specialist referrals, or medication use. From a broader societal view that includes work productivity, the picture shifted. Lower costs from reduced work absence essentially balanced out the higher rehabilitation spending, making total costs nearly equivalent between groups.

The economic analysis found the probability that PREVSAM represented better value for money was approximately 50% when compared against standard Swedish cost-effectiveness thresholds of €43,000 to €86,000 per QALY gained. This means the intervention was neither clearly cost-effective nor clearly wasteful by conventional economic standards. The researchers explicitly concluded that neither strategy emerged as preferable on economic grounds.

The authors identified a critical limitation: high individual variation in outcomes suggests the screening process needs refinement. Not all patients flagged as high-risk by the questionnaire responded equally to the structured approach. This points to a real problem in current clinical practice: screening tools may be casting too wide a net, leading to resource allocation that doesn't match individual need.

What this means for you

If you have musculoskeletal pain with concern about missing work, this study suggests that receiving structured team-based rehabilitation versus standard primary care produces equivalent health outcomes over one year. The choice between approaches may reasonably depend on factors beyond economics: access, preference, and local care delivery models.

The study's most actionable finding relates to screening. The fact that a high-risk designation (score of 40+) didn't reliably predict who would benefit from intensive intervention suggests that pain questionnaires alone may not be sufficient for determining treatment strategy. More nuanced assessment tools, potentially including psychosocial factors, work-related stressors, or functional capacity measures, might better identify which patients truly need structured rehabilitation.

For clinicians and healthcare systems, the data support a pragmatic approach: standardized screening for musculoskeletal pain risk is reasonable, but subsequent treatment decisions should account for individual factors beyond questionnaire scores. Intensive rehabilitation resources may be appropriately reserved for a narrower subset of high-risk patients than current screening thresholds would suggest.

Study details

Sources

Abelli A, et al. Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): a cost-effectiveness analysis comparing team-based rehabilitation in primary care vs treatment as usual. *BMC Health Services Research*. Published online. PubMed.