Return on Investment of the Back At Work After Surgery (BAAS) Care Pathway Compared to Care-as-Usual in Knee Arthroplasty.
Daniël O Strijbos, A Carlien Straat, Geert van der Sluis and 5 others
PMID 40971108WHAT IT FOUND
A bundled BAAS pathway for knee arthroplasty, including preoperative and postoperative physical therapy, goal setting, activity monitoring, occupational workplace assessment, and coordinated return-to-work planning, was associated with lower employer and societal costs over 12 months.
Key findings
01Compared with care-as-usual, BAAS had lower absenteeism costs (€7,263), lower primary care costs (€489), lower total employer costs (€4,493), and lower total societal costs (€4,982), with reported ROI of 590% societal and 532% employer.
02The complete-case sensitivity analysis reported differences in productivity loss (€2,814, p = 0.220) and total societal costs (€2,409, p = 0.313).
03The BAAS intervention cost €845 per patient and combined hospital-based physical therapist preoperative consultation, Goal Attainment Scaling for a work-related goal, accelerometer feedback, an occupational assessor workplace report, postoperative consultations, an online team meeting, and primary care physical therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The groups were not randomly assigned, so matching can only adjust for measured baseline differences. Education remained imbalanced after matching, and the authors state that residual confounding by education cannot be ruled out. Patients with two or more comorbidities were over-represented in the care-as-usual group after matching, which may affect cost comparisons. The study was conducted in the Netherlands, where healthcare reimbursement and sick leave rules may differ from other countries. Follow-up was only 12 months, so longer-term return-to-work relapse and costs were not assessed. The cost analysis did not include one-off implementation costs such as staff training, local protocol development, and monitoring devices. Workplace accommodations were advised if needed but were not recorded, so employer cost savings may be overestimated. Presenteeism was measured by questionnaire about days worked with reduced productivity, not by direct measurement of reduced production. The complete-case sensitivity analysis reported p = 0.220 for productivity loss and p = 0.313 for total societal costs.
Declared interests
The study was funded by ZonMw.
The easy way to misread this
Do not read the reported return on investment as proof that BAAS will save money in every hospital. The study was not randomised, did not include one-off implementation costs, and the complete-case sensitivity analysis reported p = 0.220 for productivity loss and p = 0.313 for total societal costs.
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