***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Little is known about the cost-effectiveness of preventing mental disorders . AIMS To study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder . METHOD An economic evaluation was conducted alongside a r and omised clinical trial . Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care ( n=107 ) or to usual care alone  ( n=109 ) . RESULTS Primary care patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18 % to 12 % . In addition , this intervention had a 70 % probability of being more cost-effective than usual care alone . A sensitivity analysis indicated the robustness of these results . CONCLUSIONS Over 1 year adjunctive minimal contact psychotherapy  improved outcomes and generated lower costs . This intervention is therefore superior to usual care alone in terms of cost-effectiveness BACKGROUND The cost-utility of brief therapy compared with cognitive-behavioural therapy ( CBT ) and care as usual in the treatment of depression and anxiety has not yet been determined . AIMS To assess the cost-utility of brief therapy compared with CBT and care as usual . METHOD A pragmatic r and omised controlled trial involving 702 patients was conducted at 7 Dutch mental healthcare centres ( MHCs ) . Patients were interviewed at baseline and then every 3 months over a period of 1.5 years , during which time data were collected on direct costs , indirect costs and quality of life . RESULTS The mean direct costs of treatment at the MHCs were significantly lower for brief therapy than for CBT and care as usual . However , after factoring in other healthcare costs and indirect costs , no significant differences between the treatment groups could be detected . We found no significant differences in quality -adjusted life-years between the groups . CONCLUSIONS Cost-utility did not differ significantly between the three treatment groups A cost-effectiveness ( CE ) analysis was performed of Bassini versus laparoscopic repair for primary inguinal hernia .  Incremental costs per 1-year recurrence-free patient were calculated for the societal and hospital perspective . From the hospital perspective , the incremental CE ratio of laparoscopic repair is 5.348 guilders . From the societal perspective , laparoscopic repair is both less costly and more effective than Bassini repair . Results were sensitive to assumptions about recurrence rates , laparoscopic operating time , and return to work .  Laparoscopic repair should replace Bassini repair in order to benefit society . From the hospital perspective , the decision to accept laparoscopic repair depends on the willingness to pay Background Increased physical activity levels benefit both an individuals ' health and productivity at work . The purpose of the current study was to explore the impact and cost-effectiveness of a workplace physical activity intervention design ed to increase physical activity levels . Methods A total of 1260 participants from 44 UK worksites ( based within 5 organizations ) were recruited to a cluster r and omized controlled trial with worksites r and omly allocated to an intervention or control condition . Measurement of physical activity and other variables occurred at baseline , and at 0 months , 3 months and 9 months post-intervention . Health outcomes were measured during a 30 minute health check conducted in worksites at baseline and 9 months post intervention . The intervention consisted of a 3 month tool-kit of activities targeting components of the Theory of Planned Behavior , delivered in-house by nominated facilitators . Self-reported physical activity ( measured using the IPAQ short-form ) and health outcomes were assessed . Results and discussion Multilevel modelling found no significant effect of the intervention on MET minutes of activity ( from the IPAQ ) at any of the follow-up time points controlling for baseline activity . However , the intervention did significantly reduce systolic blood pressure ( B = -1.79 mm/Hg ) and resting heart rate ( B = -2.08 beats ) and significantly increased body mass index ( B = .18 units ) compared to control . The intervention was found not to be cost-effective , however the substantial variability round this estimate suggested that further research is warranted . Conclusions The current study found mixed support for this worksite physical activity intervention . The paper discusses some of the tensions involved in conducting rigorous evaluations of large-scale r and omized controlled trials in real-world setting s . Trial registration Current controlled trials IS RCT Abstract Objective : To evaluate the cost effectiveness of physiotherapy , manual therapy , and care by a general practitioner for patients with neck pain . Design : Economic evaluation alongside a r and omised controlled trial . Setting : Primary care . Participants : 183 patients with neck pain for at least two weeks recruited by 42 general practitioners and r and omly allocated to  manual therapy ( n=60 , spinal mobilisation ) , physiotherapy ( n=59 , mainly exercise ) , or general practitioner care ( n=64 , counselling , education , and drugs ) . Main outcome measures : Clinical outcomes were perceived recovery , intensity of pain , functional disability , and quality of life . Direct and indirect costs were measured by means of cost diaries that were kept by patients for one year . Differences in mean costs between groups , cost effectiveness , and cost utility ratios were evaluated by applying non-parametric bootstrapping techniques . Results : The manual therapy group showed a faster improvement than the physiotherapy group and the general practitioner care group up to 26 weeks , but differences were negligible by follow up at 52 weeks . The total costs of manual therapy ( € 447 ; £ 273 ; $ 402 ) were around one third of the costs of physiotherapy ( € 1297 ) and general practitioner care ( € 1379 ) . These differences were significant : P<0.01 for manual therapy versus physiotherapy and manual therapy versus general practitioner care and P=0.55 for general practitioner care versus physiotherapy . The cost effectiveness ratios and the cost utility ratios showed that manual therapy was less costly and more effective than physiotherapy or general practitioner care . Conclusions : Manual therapy ( spinal mobilisation ) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner . What is already known on this topic The cost of treating neck pain is considerable Many conservative interventions are available , such as prescription drugs , yet their cost effectiveness has not been evaluated No r and omised trials of conservative treatment for neck pain have so far included an economic evaluation What this study adds Manual therapy is more effective and less costly than physiotherapy or care by a general practitioner for treating neck pain Patients undergoing manual therapy  recovered more quickly than those undergoing the other Study Design . An economic evaluation alongside a r and omized clinical trial in primary care . A total of 135 patients were r and omly allocated to physical therapy added to general practitioners ’ care ( n = 67 ) or to general practitioners ’ care alone ( n = 68 ) . Objective . To evaluate the cost-effectiveness of physical therapy and general practitioner care for patients with an acute lumbosacral radicular syndrome ( LRS , also called sciatica ) compared with general practitioner care only . Summary of Background Data . There is a lack of knowledge concerning the cost-effectiveness of physical therapy in patients with sciatica . Methods . The clinical outcomes were global perceived effect and quality of life . The direct and indirect costs were measured by means of question naires . The follow-up period was 1 year . The Incremental Cost-effectiveness Ratio ( ICER ) between both study arms was constructed . Confidence intervals for the ICER were calculated using Fieller ’s method and using bootstrapping . Results . There was a significant difference on perceived recovery at 1-year follow-up in favor of the physical therapy group . The additional physical therapy did not have an incremental effect on quality of life . At 1-year follow-up , the ICER for the total costs was & U20AC;6224 ( 95 % confidence interval , −10419 , 27551 ) per improved patient gained . For direct costs only , the ICER was & U20AC;837 ( 95 % confidence interval , −731 , 3186 ) . Conclusion . The treatment of patients with LRS  with physical therapy and general practitioners’care is not more cost-effective than general practitioners’care alone BACKGROUND Sickness absence often occurs in patients with emotional distress or minor mental disorders . In several European countries , these patients are over-represented among those receiving illness benefits , and interventions are needed . The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers , design ed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders . METHODS In this R and omized Controlled Trial , patients were recruited by GPs . The intervention group ( N = 98 ) received an activating , structured treatment by social workers , the  control group ( N = 96 ) received routine GP care .  Sick leave duration , clinical symptoms , and medical consumption ( consumption of medical staffs ' time as well as consumption of drugs ) were measured at baseline and 3 , 6 , and 18 months later . RESULTS Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups . Also the associated costs were not significantly lower in the intervention group . CONCLUSIONS Compared with usual GP care , the activating social work intervention was not superior in reducing sick leave duration , improving clinical symptoms , and decreasing medical consumption . It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders . Therefore , further implementation of the intervention is not justified . Potentially , programmes aim ed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace ( e.g. by occupational physicians ) are more successful than programmes in primary care Background Exercise therapies generate substantial costs in computer workers with non-specific work-related upper limb disorders ( WRULD ) . Aims To study if postural exercise therapy is cost-effective compared to regular physiotherapy in screen-workers with early complaints , both from health care and societal perspective . Methods Prospect i ve r and omized trial including cost-effectiveness analysis ; one year follow-up . Participants : Eighty-eight screen-workers with early non-specific WRULD ; six drop-outs . Interventions : A ten week postural exercise program versus regular physiotherapy .  Outcome measures : Effectiveness measures : Pain : visual analogous scale ( VAS ) , self-perceived WRULD ( yes/no ) . Functional outcome : Disabilities of Arm , Shoulder and H and - Dutch Language Version ( DASH-DLV ) . Quality of life outcome : EQ-5D.Economic measures : health care costs including patient and family costs and productivity costs result ing in societal costs . Cost-effectiveness measures : health care costs and societal costs related to the effectiveness measures . Outcome measures were assessed at baseline ; three , six and twelve months after baseline . Results At baseline both groups were comparable for baseline characteristics except scores on the Pain Catastrophizing Scale and comparable for costs . No significant differences between the groups concerning effectiveness at one year follow-up were found . Effectiveness scores slightly improved over time . After one year 55 % of participants were free of complaints . After one year the postural exercise group had higher mean total health care costs , but lower productivity costs compared to the physiotherapy group . Mean societal costs after one year ( therefore ) were in favor of postural exercise therapy [ - € 622 ; 95 % CI -2087 ; + 590 ) ] . After one year , only self- perceived WRULD seemed to result in acceptable cost-effectiveness of the postural exercise strategy over physiotherapy ; however the probability of acceptable cost-effectiveness did not exceed 60%.Considering societal costs related to QALYs  , postural exercise therapy had a probability of over 80 % to be cost-effective over a wide range of cost-effectiveness ceiling ratios ; however based on a marginal QALY-difference of 0.1 over a 12 month time frame . Conclusion Although our trial failed to find significant differences in VAS , QALYs and ICERs based on VAS and QALYs at one-year follow-up , CEACs suggest that postural exercise therapy according to Mensendieck/Cesar has a higher probability of being cost-effective compared to regular physiotherapy ; however further research is required . Trial registration IS RCT N OBJECTIVES Major depression is common in elderly patients .  Interpersonal psychotherapy ( IPT ) is a potentially effective treatment for depressed elderly patients . The objective of this study was to evaluate the cost-effectiveness of IPT delivered by mental health workers in primary care practice s , for depressed patients 55 years of age and older identified by screening , in comparison with care as usual ( CAU ) . METHODS We conducted a full economic evaluation alongside a r and omized controlled trial comparing IPT with CAU . Outcome measures were depressive symptoms , presence of major depression , and quality of life . Re source use was measured from a societal perspective over a 12-month period by cost diaries . Multiple imputation and bootstrapping were used to analyze the data . RESULTS At 6 and 12 months , the differences in clinical outcomes between IPT and CAU were small and nonsignificant . Total costs at 12 months were Euros 5,753 in the IPT group and Euros 4,984 in the CAU group ( mean difference , Euros 769 ; 95 percent confidence interval , -2,459 -3,433 ) . Cost-effectiveness planes indicated that there was much uncertainty around the cost-effectiveness ratios . CONCLUSIONS Based on these results , provision of IPT in primary care to elderly depressed patients was not cost-effective in comparison to CAU . Future research should focus on improvement of patient selection and treatments that have more robust effects in the acute and maintenance phase of treatment An intervention that can prevent low back pain ( LBP ) becoming chronic , may not only prevent great discomfort for patients , but also save substantial costs for the society . Psychosocial factors appear to be of importance in the transition of acute to chronic LBP . The aim of this study 
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Conclusions Few health economic studies have estimated productivity costs using the friction cost approach .
The estimation and reporting of productivity costs using this method appears to differ in quality by country .