 |
Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 2026 ICMPE. |
 |
The Cost-Utility of a Workplace Mental Health Program for Employees with Common Mental Disorders (FRIAA Project) |
Nadine Mulfinger,1 Tamara Waldmann,2 Regina Herold,3 Jeannette Weber,4 Meike Heming,4 Manuel Feißt,5 Christoph Kröger,6 Marieke Hansmann,6 Harald Gündel,7 Nicole R. Hander,7 Eva Rothermund-Nassir,7 FRIAA-study group, Reinhold Kilian1 |
1Department of Psychiatry II, Section of Health Economics and Psychiatric Services Research, Ulm University & BKH Günzburg, Günzburg, Germany. 2Department of Psychiatry II, Section of Health Economics and
Psychiatric Services Research, Ulm University & BKH Günzburg, Günzburg, 3Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany. 4Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. 5Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany. 6University Hildesheim, Hildesheim, Germany. 7Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany. |
*Correspondence to: Dr. Nadine Mulfinger, Department Psychiatry II, Section of Health Economics and Psychiatric Services Research, Ulm University & BKH Günzburg, Lindenallee 2, 89312, Günzburg, Germany.
E-mail: nadine.mulfinger@uni-ulm.de
Source of Funding: The study was conducted as part of the Early Intervention at Work project funded by the German Federal Ministry of Education and Research (BMBF) under the project number 01GX1902. The BMBF had no role in the study design, data collection, data analysis, data interpretation, or publication of the study results.
|
|
| Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement, resulting in substantial economic costs. This study evaluates the cost-effectiveness of the FRIAA intervention compared to care as usual (CAU) for employees with CMDs in Germany. Data were derived from a multicenter randomized controlled trial including 549 employees from companies near five study centers, of whom 545 were included in the economic evaluation. Health and social care utilization was assessed using the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured using the EQ-5D-5L, and quality-adjusted life years (QALYs) were used in the cost-utility analysis. Annual costs were significantly higher in the FRIAA group than in the CAU group (€3,484.29 difference), though no statistically significant difference in QALYs was observed. The incremental cost-utility ratio was €165,918.57 per additional QALY gained, indicating that the FRIAA intervention cannot be considered cost-effective compared to CAU. | |
Background: Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement due to health problems. Early identification and treatment of CMDs may have a positive impact on prognosis and associated economic costs, including healthcare expenditure, lost productivity, and the societal burden. The effectiveness of workplace psychotherapeutic interventions has been studied, but information on cost-effectiveness in this population is lacking.
Aims of the Study: This study evaluates the cost-effectiveness of the FRIAA intervention for employees with CMDs compared to care as usual (CAU), with the aim of reducing sickness absence and preventing early retirement.
Methods: We used data from a multicenter randomized controlled trial involving 549 employees with mental health problems in different companies located near five study centers in Germany, who provided data at nine- and 15-month follow-up. A total of 545 records were available for the economic evaluation (EE). 278 participants were assigned to the intervention group (FRIAA), and 267 participants were assigned to the CAU condition. On average, intervention participants received eight intervention sessions. The use of health and social care services was assessed using the Client Sociodemographic and Service Receipt Inventory (CSSRI) at nine- and 15-month follow-up. Data were transformed to a 12-month reference period. Quality of life was measured using the EQ-5D-5L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional quality adjusted life year (QALY).
Results: The annual cost difference between FRIAA and CAU was € 3,484.29 (95 % confidence interval [CI] € 1,033.91 to € 5,934.67), which was significant (p = 0.005). We estimated the average QALY in the CAU group to be 0.768 (SD = 0.200) and in the FRIAA-group to be 0.789 (SD = 0.192). The difference in QALY between FRIAA and CAU was 0.021 (95 % CI -0.013 to 0.055), which was not significant (p = 0.203). The incremental cost-utility ratio (ICUR) showed that the intervention was associated with costs of € 165,918.57 for one additional year of full health.
Discussion: As far as we know, this was the first EE of a psychotherapeutic consultation at work called FRIAA. Compared to CAU, FRIAA did not result in improved quality of life in terms of QALYs, nor favourable cost-utility for FRIAA compared with CAU. The FRIAA intervention cannot be considered cost-effective compared to CAU.
Implications: This EE found that differences in costs were significant (with higher costs in the FRIAA group), while no statistically significant differences in QALYs were observed between the study groups. In addition, the cost-utility for FRIAA compared with CAU was not favourable. Participants with CMDs may need more time to integrate what they discuss in psychotherapy sessions into their daily lives before they can improve their personal quality of life and thus show long-term changes in sick days. Longer follow-up periods may be needed in future studies. |
Received 3 November 2025; accepted 6 February 2026
Copyright © 2026 ICMPE