• P Loisel, J Lemaire, S Poitras, M-J Durand, F Champagne, S Stock, B Diallo, and C Tremblay.
• Department of Surgery (Division of Orthopedics), Université de Sherbrooke and Centre de recherche clinique en réadaptation au travail PREVICAP, Hôpital Charles LeMoyne, 1111, Longueuil, Québec, Canada, J4K 5G4. patrick.loisel@usherbrooke.ca
• Occup Environ Med. 2002 Dec 1; 59 (12): 807-15.

AimsTo test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention.MethodsA randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care.ResultsAt the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm.ConclusionsA fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers' compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

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