Cost-Consequence Analysis of Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes

Cost-Consequence Analysis of Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-Consequence Analysis of Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes Arie Arizandi Kurnianto, Faten Amer, Ananda Dellina Putri, Ade Paranata, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7311475/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose : This study aims to address the challenge of Return To Work program by evaluating the cost consequences of the implementation of RTW program. Therefore, the principal research question is whether the RTW program produces better health outcomes, health costs, and productivity loss compared to standard care. Methods : A retrospective observational study was conducted by using occupational injury claims from 2012 to August 2022. The study included 11,955 claims, with 1,353 identified as RTW cases and 10,602 as non-RTW cases. Outcome measures included Lost Time Injury Days (LTIDs), the RTW rates, and the efficiency of medical care expenses. A cost-consequence analysis was performed to assess the economic and productivity impact. Results: There was a significant difference between the RTW and non-RTW groups in terms of LTIDs (p < 0.001) and labor market outcomes (p < 0.001). The RTW program showed higher initial costs ($822.50 per case vs $262.25) but demonstrated superior economic efficiency over time due to reduced lost workdays (350.3 vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20). Conclusion : The Return To Work (RTW) program works to reintegrate workers into the workforce while also providing significant economic benefit. Future studies could also analyze how productivity growth differs across geographical regions. Cost-Consequences Analysis Return To Work Disability Occupational Accidents Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Occupational injuries have a significant economic and social impacts, particularly in developing nations where Return To Work (RTW) programs are limited ( 1 – 4 ). The Return to Work (RTW) program in Indonesia is administered by BPJS Ketenagakerjaan, the national social security agency, is a formalized rehabilitation and return to work program to assist workers who have sustained a work-related injury and are disabled, to return to gainful employment ( 5 – 7 ). Moreover, RTW program was formed nationally in 2015, to provide a formalized RTW program that integrates medical treatment, vocational rehabilitation, prosthetics and orthotics, workplace adaptation, and psychosocial support. In addition, RTW services could begin as early as when workers have reported their on-the-job injury, followed by a medical assessment and rehabilitation plan, and all support is to be coordinated among the RTW coordinator (case manager), the healthcare provider, and the employer. Workers that present must be in the diagnosis of partial or total permanent disability as a result of a workplace occupational accident or commuting injury ( 7 – 9 ). The goals of the RTW program are to promote capacity building to restore functional capacity, decrease the number of lost workdays, and decrease the social and economic burden associated with work disability ( 7 , 10 , 11 ). In fact, in 2021, Indonesia recorded 234,370 work accidents and work-related diseases, including 6,565 cases in the mining sector ( 12 ). While RTW programs have existed in developed countries for several years, Indonesia only introduced its RTW program in 2015 ( 5 ), and evidence of its effectiveness remains limited, particularly in terms of economic and productivity outcomes. In addition, the costs and consequences borne by social security providers, employers, and disabled workers, especially those with occupational injuries, managed in RTW program have not received much attention ( 13 – 15 ). Severe injuries can lead to permanent disability, loss of income, and a decline in overall quality of life ( 16 – 18 ). Furthermore, occupational accidents impose significant financial burdens on employers and the healthcare system due to increased medical claims, loss of productivity, and higher insurance costs ( 16 , 19 ). Implementing an effective RTW program can be an important strategy for reducing the costs of workplace injuries for both workers and employers. A structured rehabilitation and reintegration program improves recovery outcomes and supports the successful return of injured workers to employment ( 20 , 21 ). Moreover, disabled workers participated in RTW program are more likely to regain purpose and reduce the risk of long term incapacity due to continued access to medical treatment and rehabilitation, which advances complete health results and decreases complications ( 22 – 25 ). Furthermore, the most significant advantages of RTW program is its function in reducing prolonged impairment or Lost Time Injury Days (LTIDs) through enhanced physical rehabilitation ( 22 , 26 ). Although the path to recuperation varies by way of person, early intervention and a collaborative technique between all events usually yield the finest outcomes for maintaining disabled staff participating within the workforce, which leads to lower turnover rates, saving on recruitment and training costs, and contributes to maintaining high levels of productivity. Additionally, the outcomes of RTW program aligns with Indonesia's broader efforts to meet the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), and SDG 10 (Reduced Inequalities) by promoting the reintegration of disabled workers back into the labor force, the program not only aims to improve health outcomes but also contributes to economic progress and social inclusion. The main objective of this study is to assess the economic impact and productivity outcomes of the RTW program in Indonesia. Specifically, this study examines the impact of the RTW program on Lost Time Injury Days (LTIDs), medical care costs, and the productivity outcomes of disabled workers returning to the labor market. This assessment critically reviews the impact of the RTW program, aiming not only help workers who want to return to the workforce, but also to support the mitigation of the economic impact of work accidents. Therefore, this study adopts a cost-consequence analysis (CCA) approach to investigate economic and social outcomes, providing a holistic view of the potential impact of RTW programs in developing countries. In regard, cost-consequence analysis (CCA) offers a framework for thoroughly assessing the economic and social impact of RTW programs ( 27 , 28 ). The approach of this study covers multiple dimensions including the health outcome, economic benefits and productivity improvements that result from RTW program. Occupational safety remains a major concern in most developing countries, including Indonesia ( 29 , 30 ). Using these outcomes, we would like to give perspective both the policy maker and other stakeholders with valuable information for future decision making. Methods Study design This study used a retrospective observational design that is useful for understanding the epidemiology and impact of health(23–25). Moreover, the cost-consequence analysis (CCA) methodology was used representing a broad range of economic (direct costs, savings), health (Lost Time Injury Days, LTIDs) and productivity (return-to-work rates) outcomes in disaggregated form rather than synthesized to one ratio. This approach allows to conduct a thorough assessment of the emerging effects in different areas related to the program. Data sources and sampling strategy The study recruited workers who experienced an occupational injury resulting in disability. To qualify, participants must have finished either the RTW program or usual care from 2012 to 2022, with closed claims by August 2022. Only those with terminated claims, undergoing treatment under the coverage of social security by BPJS Ketenagakerjaan (Indonesian National Social Security Agency on Employment) and injuries inducing disability were incorporated. This methodology made certain the analysis exclusively evaluated instances where the RTW program could perceptibly impact health results, economic consequences, and productivity measures. Varied workers experienced different recoveries, some struggled for months with pain and diminished function while others adapted well despite the challenges. The program aimed to speed healing and restore independence through accommodations, counseling, and early return considering individual circumstances and limitations. Cost-Consequence Analysis (CCA) Framework The Cost-Consequence Analysis framework employed in this research separated the appraisal of expenses and results into three critical classes: medical impacts, financial results, and profitability outcomes (26,27). This study independently exhibited every one of these results for both the RTW program and standard consideration, empowering choice producers to freely examine the expenses and advantages of each alternative. While the RTW program demonstrated higher expenses, it created considerably more noteworthy wellbeing and profitability yields than conventional treatment. The choice to receive the RTW program ought to rely upon how policymakers’ weight these contrasting expense and result measurements. Costs Medical care costs vary considerably across recovery methods. This includes all expenses associated with surgery, rehabilitation, and follow-ups. Costs will be meticulously calculated for both rapid return-to-work and standard care groups in Indonesian Rupiah (IDR) then converted to American dollars (USD). Moreover, Lost time from work due to injuries or lost time injury days (LTIDs), differs dramatically between approaches. Calculating the economic impact of these absent days allows an assessment of delayed recovery's financial toll for both groups. Employer costs change substantially depending on the recovery method used. The study will examine reductions in absenteeism, disability claims, and temporary replacements, comparing savings between rapid return-to-work and standard care to determine the approach's fiscal influence. Outcomes The primary outcome involves the return-to-work percentage, showing the portion of workers successfully reintegrating after the rapid program versus standard care. Additionally, reduced lost time injury days serve as a proxy for improved well-being, with fewer absent days signifying swifter healing and more effective rehabilitation. Productivity outcomes will be assessed by analyzing reduced lost time injury days and economic contributions from active employees. Faster re-employment progress expected yields massive productivity increases, compared between the rapid and standard care groups. Statistical analysis The Cost-Consequence Analysis (CCA) will involve a direct comparison of costs and outcomes between the RTW program and usual care. Descriptive statistics will be used to summarize the costs (e.g., medical expenses, LTIDs) and outcomes (e.g., return-to-work rates, productivity gains) for each group. The research was conducted with retrospective observational design, comparing pre- and post-implementation RTW policies for occupational injuries necessitating surgery. We compiled data on the quantity of LTIDs and medical expenditures for job-associated injuries necessitating surgery across a decade. It proves particularly useful for scrutinizing the impacts of policy changes, for instance enactment of a RTW initiative(28–32). Some cases necessitated prolonged recovery or rehabilitation, creating higher costs than anticipated. However, other cases saw workers able to return to employment sooner than forecasted due to supportive RTW accommodations, offsetting some expenses. Overall, the analysis aimed to discern the complex influences of RTW policies on various outcomes over an extended time horizon. In our study, the inclusion criteria of eligible cases were determined and included in the analysis if relevant regarding the effectiveness of RTW programs for occupational injury cases. The first inclusion criterion was that the case was a work injury that resulted in partial anatomical disability, partial functional disability, or total permanent disability. Then, the case was handled by a provider with an occupational accident and RTW insurance coverage program; and the case was closed. From the screened claims, 10,602 cases received usual care, while 1,353 cases received the RTW program. Moreover, we compared LTIDs and medical treatment costs between usual care and RTW program claims using segmentation analysis to assess the effectiveness of the RTW program. This analysis allowed us to model the trend in cost consequences of the usual care intervention in the outcome variable and estimate the change in trend after the RTW program intervention. We also used graphical representations, to visually assess trends in the distribution of components of each type of care. Furthermore, we used a graphical representation, to visually assess trends in the distribution of components of each treatment type. In addition, we included covariates such as age, gender, distribution of cases within the coverage area and industry sector to address potential confounding variables and ensure the accuracy of the analysis. Statistical software, including SPSS version 25.0, was used to conduct comprehensive data analysis, and a significance level of p < 0.05 was set. R Studio version 4.2.2 was used for data visualization purposes. Ethics This study has received ethical approval from the Health Research Ethics Committee, Faculty of Public Health, Universitas Airlangga, with number: 58/EA/KEPK/2021. This study has been deemed to meet ethical criteria based on 7 (seven) WHO Standards 2011, in accordance with the 2016 CIOMS Guidelines. Results In this study, the results of the descriptive analysis are presented in Table 1. A comprehensive understanding of the pattern of occupational injuries across several subgroups of workers can be depicted in the descriptive statistical analysis for each category. Moreover, valuable insights into the nature and extent of occupational injuries were gained from the findings of the descriptive analysis, which can be used to inform and guide injury prevention and management strategies. A total of 11,955 injured workers were observed, comprising 1,353 participants enrolled in the RTW program and 10,602 who received usual care. In this study, 11,955 claims of workers injured in work accidents were observed, consisting of 1,353 participants enrolled in the RTW program and 10,602 who received usual care. The baseline characteristics are outlined in Table 1 , along with attributes such as age, gender, and industry sector. The participants' mean age was 34.5 years with a standard deviation of 6.1 years in the RTW group and 35.3 years with a standard deviation of 5.8 years in the usual care group - a non-significant difference between the two. Moreover, most of the participants in both categories were male, at 86% of the RTW group and 87% of the usual care group. Furthermore, industry domains included manufacturing, agriculture, and transport, with comparable distribution across the two groups. This study also presents an exploration of the model of RTW program implemented in Indonesia within the scope of social security employment ( Figure 1) . Based on the regional distribution (Figure 2) , there are significant disparities (p<0.001) in participant distribution between RTW Program and Usual Care across most regions in Indonesia. The most notable differences are observed in three key regions: West Java shows a substantially higher representation in the RTW Program (22.4% vs 9.2%), while Central Java has a markedly higher proportion in Usual Care (29.1% vs 16.9%). Northern Sumatra also shows considerable variation (19.3% in Usual Care vs 12.9% in RTW Program). Only three regions - East Java (p=0.547), Banten (p=0.642), and East Indonesia (p=0.234) - show no statistically significant differences between the two programs, suggesting more balanced participation rates in these areas. This regional variation highlights potential geographical disparities in program implementation and accessibility across Indonesia's different regions. Table 1 Baseline Sample Characteristics Variable RTW Program (n = 1,353) Usual Care (n = 10,602) p-value Category of age Age (mean, SD) 34.0 (6.1) 35.0 (5.8) 0.042 15-24 y.o 24.0 20.4 0.003 25-54 y.o 73.2 76.4 0.012 ≥ 55 y.o 2.7 3.1 0.451 Gender Male 86.1 87.3 0.215 Female 13.9 12.7 0.215 Outcomes of treatment Successful 84.0 20.3 <0.001 Unsuccessful 16.0 79.7 <0.001 Industry Manufactures 45.2 43.8 0.324 Agriculture 15.3 16.1 0.456 Mining 5.1 4.8 0.678 Animal husbandry/Fisheries 3.2 3.5 0.543 Transportation 12.8 13.2 0.412 Unspecified Industries 18.4 18.6 0.678 Type of Impairment Partly Anatomical Impairment 10.1 9.8 0.234 Partly Functional Impairment 5.6 5.9 0.456 Total Impairment 2.3 2.5 0.678 Location of Accident At work 65.0 60.0 0.234 Commuting 25.0 30.0 0.456 Outside 10.0 10.0 0.678 notes: Values are presented as mean (SD) for continuous variables and percentages for categorical variables p-values were calculated using t-tests for continuous variables and chi-square tests for categorical variables Statistical significance was set at p < 0.05 Financial Breakdown of Cost Elements Analysis of cost components, as shown in Figure 3 , reveals substantial differences between the RTW program and usual care approaches. Direct medical costs in the RTW program averaged $822.50 per case, compared to $262.25 in usual care, reflecting the intensive initial investment in comprehensive rehabilitation. However, rehabilitation services costs ($212.73 vs $42.19) and prosthetic/orthotic devices costs ($418.64 vs $278.45) demonstrated more efficient resource utilization in the RTW program despite higher initial investments. The second major cost component analysis shows that transportation costs ($36.98 vs $10.10) and disability compensation ($1,832.13 vs $1,133.10) were higher in the RTW program initially. However, these higher upfront costs were offset by significantly reduced lost workdays (350.3 days vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20), indicating better economic efficiency in the RTW program over time. Economic Impact and Effectiveness Analysis The comprehensive cost-consequence analysis presented in Table 3 demonstrates the superior economic efficiency of the RTW program compared to usual care. The total direct costs, including medical treatment, rehabilitation, prosthetics/orthotics, and transportation, amounted to $1,246.28 per case in the RTW program compared to $392.28 in usual care. However, when considering the broader economic impact, including productivity losses, the RTW program showed a more favorable total cost profile ($47,485.88 vs $28,653.48), primarily due to its effectiveness in reducing lost workdays and improving return-to-work outcomes. Further analysis of cost-effectiveness reveals that the cost per LTID (Lost Time Injury Day) was comparable between the two approaches ($135.56 vs $133.83), but the RTW program achieved significantly better outcomes. The most striking difference was observed in the return-to-work rates, where the RTW program achieved an 84.0% success rate compared to 20.3% in usual care, representing a substantial 63.7% improvement. This difference, combined with the cost analysis, suggests that while the RTW program requires higher initial investment, it provides better value for money through improved outcomes and long-term cost savings. Table 2 Variable description Variable Name Description Unit Category Medical Treatment Direct medical costs including consultations, procedures, and medications for injury treatment USD per case Direct Cost Rehabilitation Services Specialized rehabilitation services including physical therapy and recovery programs USD per case Direct Cost Prosthetics Orthotic Devices Costs for artificial limbs, support devices, and assistive technologies USD per case Direct Cost Transportation Patient transportation expenses for medical visits and treatments USD per case Direct Cost Disability Compensation Financial compensation provided during disability period USD per case Direct Cost Total Direct Cost Aggregate of all medical, rehabilitation, prosthetic, and transportation costs USD per case Direct Cost LTIDs Total number of work days lost due to injury/disability Days Time Measure Productivity Loss Cost Economic value of productivity lost during disability period USD per case Indirect Cost Total Cost Sum of all direct costs and productivity loss costs USD per case Total Cost Cost per LTIDs Total cost divided by number of lost time injury days USD per day Cost Efficiency RTW Rate Percentage of workers who successfully returned to work Percentage (%) Outcome Measure Table 3 Cost Consequences Analysis Cost Component RTW Program Usual Care Difference (RTW - Usual) A. Direct Costs 1. Medical treatment $822.50 $262.25 $560.25 2. Rehabilitation services $212.73 $42.19 $170.54 3. Prosthetic/Orthotic devices $418.64 $278.45 $140.19 4. Transportation $36.98 $10.10 $26.88 5. Disability compensation $1,832.13 $1,133.10 $699.03 B. Total Direct Costs $1,246.28 $392.28 $854.01 C. Indirect Costs 1. Lost Time Injury Days (LTIDs) 350.3 214.1 136.2 2. Productivity loss costs $46,239.60 $28,261.20 $17,978.40 D. Total Costs (B + C2) $47,485.88 $28,653.48 $18,832.41 E. Cost per LTID day (D/C1) $135.56 $133.83 $1.73 F. Return to Work Rate (%) 84.0 20.3 63.7 Moreover, the boxplot in Figure 4 illustrates the distribution of medical costs between the RTW Program and Usual Care groups. The RTW Program shows a higher median cost, with the box (interquartile range) extending from approximately USD 425 to USD 550, and a median around USD 500. The whiskers extend from about USD 250 to USD 750, with several outliers above USD 800 and below USD 200, indicating some cases with exceptionally high or low medical costs. In comparison, the Usual Care group demonstrates lower overall costs, with a median around USD 400, and an interquartile range from approximately USD 350 to USD 450. The whiskers for this group extend from about USD 200 to USD 600, with some outliers reaching up to USD 700. This distribution suggests that while the RTW Program generally incurs higher medical costs, it also shows greater variability in cost distribution, potentially reflecting a more individualized and comprehensive approach to medical care. The presence of outliers in both groups indicates that some cases required significantly more medical resources than typical, regardless of the program type. Annual and cumulative productivity loss comparisons show significantly lower productivity losses over time for RTW participants compared with usual care cases. As presented in Figure 5 , the annual productivity loss of participants from the RTW program was consistently lower over years, confirming the economic validity of the program. Moreover , Figure 5 illustrates the cumulative trends in productivity losses and shows that RTW interventions reduce long new economy burdens related to lost work capacity. These findings highlight the significance of structured RTW programmes capable of improving workforce sustainability and relieving the financial burden on the social security system. Discussion Regional Disparities and Program Accessibility There is a notable disparity between urban and rural areas in terms of program accessibility and outcomes. Urban areas, particularly densely populated industrial regions, tend to have better access to RTW services and higher participation rates. Moreover, there are many hospitals, especially in rural areas, lack medical rehabilitation facilities required for the RTW program (6). Additionally, the geographical challenges posed by Indonesia's archipelagic nature, with over 13,000 islands, create significant barriers to accessing health services, including rehabilitation (33). Furthermore, there is an uneven distribution of rehabilitation professionals across the country, such as most rehabilitation professionals are concentrated in large cities, leaving rural and remote areas underserved(33). The ratios of Physical and Rehabilitation Medicine (PRM) specialists, physiotherapists, and occupational therapists per million population in Indonesia are significantly lower than in high-income countries (33). Therefore, to address this gap, it is critical to maximize program impact and ensure that all workers, regardless of location, can benefit from comprehensive rehabilitation and support. Strategies to improve the accessibility of the program may include expanding the network of health providers in underserved areas, particularly focusing on medical rehabilitation facilities. In addition, implementing strategies to improve the distribution of rehabilitation professionals across the country. Equally important is improving coordination between the various ministries responsible for disability and rehabilitation services. Economic Efficiency The economic efficiency and cost-effectiveness analysis in this study of the Return to Work (RTW) program in Indonesia offers some unique insights compared to other studies in the field of occupational rehabilitation. Unlike many studies that focus solely on direct medical costs or short-term outcomes, this research provides a comprehensive cost-consequence analysis that considers both direct and indirect costs, as well as long-term productivity gains. The study found that while the RTW program had higher initial costs ($822.50 per case compared to $262.25 for usual care), it demonstrated superior economic efficiency over time due to significantly reduced lost workdays (350.3 days vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20). This aligns with findings from other studies, such as those on Individual Placement and Support (IPS) interventions, which often show higher initial costs but better long-term outcomes(34). However, this study goes further by providing a detailed breakdown of various cost components and their distribution, offering a more nuanced understanding of where investments yield the greatest returns. The study's focus on a developing country context also sets it apart from many existing studies, which often concentrate on high-income countries (35,36). Furthermore, the inclusion of regional disparities in program implementation adds a valuable dimension not commonly addressed in other economic evaluations of RTW programs. Furthermore, based on our findings that trends indicate that the need for structured RTW programs to improvement workforce sustainability. RTW participants may face higher medical costs in the early months, but overall productivity gains and decreased disability claims more than compensate for the upfront investment — a strong economic case for sustained investment in RTW. In addition, study found that a participatory program for RTW for workers with musculoskeletal disorders led to a significant reduction of time to sustainable RTW in comparison to usual care(37). Policymakers and stakeholders may want to expand RTW access and refine program execution to capture these economic and social dividends. Implications for Rehabilitation and Workforce Reintegration The RTW program's emphasis on a comprehensive approach that addresses medical, psychological, and social needs of injured workers aligns with findings from other research, such as highlighted the importance of re-orienting health services towards maintaining employment (38). The program's effectiveness in early intervention is consistent with other study, which found that early implementation of vocational rehabilitation showed modest effectiveness on work participation (39). Furthermore, the economic benefits demonstrated by the RTW program, despite higher initial costs, are in line with findings from the International Social Security Association (ISSA) study, which showed significant returns on investment for work reintegration measures (40). However, this study offers unique insights that set it apart from existing literature. The analysis of regional disparities in program implementation and accessibility is not commonly addressed in other economic evaluations of RTW programs. This aspect provides valuable information on the challenges of implementing such programs across diverse geographical areas, particularly in a developing country context. Additionally, the study's comprehensive cost-consequence analysis, which considers both direct and indirect costs as well as long-term productivity gains, offers a more nuanced understanding of the program's economic impact compared to many other studies that focus solely on direct medical costs or short-term outcomes. These unique contributions make this study a valuable addition to the existing body of knowledge on occupational rehabilitation interventions, particularly in the context of developing countries. Conclusion The implementation of the RTW program by BPJS Ketenagakerjaan has proven to be an effective strategy for reintegrating workers with disabilities resulting from occupational injuries into the workforce. The program not only enhances return-to-work rates but also offers a more economical solution compared to usual care, with better outcomes. This study also highlighted RTW program outreach and equitable access across regions can increase the impact of the program. Long-term research should center on determining the exact parts of the RTW program that contribute most to its success, and explore approaches to optimize these factors for different local situations. In addition, long-term research could provide a deeper understanding of the long-term benefits of RTW programs, particularly in relation to sustained productivity gains and improved quality of life for employees with disabilities. Considering these areas, future analysis can help refine and expand the RTW program, which in turn can contribute to a more resilient and inclusive employment policy in Indonesia. Declarations Acknowledgments The authors would like to express their appreciation to the BPJS Ketenagakerjaan, Indonesian Social Security Agency on Employment, for sharing the data used in this study. We acknowledge that a previous iteration of this study was submitted as a thesis in order to fulfil the criteria for a PhD in Health Sciences at the University of Pécs. We are grateful for the chance to improve and broaden this study for publication. Authors Contributions Substantial contributions to the conception or design of the work: Kurnianto , the acquisition, analysis, or interpretation of data for the work: Kurnianto, Putri, Paranata. Drafting the work or revising it critically for important intellectual content: Kurnianto, Amer, Putri, Paranata . Final approval of the version to be published: Amer, Nemeskéri, Ágoston . Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Kurnianto, Nemeskéri, Ágoston. Funding Sources This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors. Ethics approval and consent to participate This study has received ethical approval from the Health Research Ethics Committee, Faculty of Public Health, Universitas Airlangga, with number: 58/EA/KEPK/2021. This study has been deemed to meet ethical criteria based on 7 (seven) WHO Standards 2011, including social value, scientific validity, fair subject selection, risk reduction, independent review, clear informed consent, and respect for the privacy and confidentiality of participants, in accordance with the 2016 CIOMS Guidelines. Fulfillment of the indicators for each standard also indicates the study's compliance with these ethical requirements. Conflict of Interest There are no conflict of interest that the authors have to declare. Data Availability Statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Clinical trial number` Not applicable References Zdanovsky V, Radionov M, Sepitchak V, Soltysik R. THE USE OF A RISK-ORIENTED APPROACH OF PRODUCTION FACTORS ASSESSMENT FOR INCREASING THE EFFICIENCY OF OCCUPATIONAL SAFETY MANAGEMENT SYSTEM. Bulletin of Lviv State University of Life Safety. 2022;24. Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Quarterly. 2011;89(4). Adei D, Agyemang-Duah W, Mensah AA. Demographic and socio-economic factors associated with exposure to occupational injuries and diseases among informal sector workers in Kumasi metropolis, Ghana. Journal of Public Health (Germany). 2022;30(9). Quinn MM, Markkanen PK, Galligan CJ, Sama SR, Lindberg JE, Edwards MF. Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides. Vol. 8, Current Environmental Health Reports. 2021. Sultan M. Collaboration Tripartite Elements Accident Reporting and Potential Hazards Management Coal Mining, Indonesia: Systematic Review. Journal of Health Science and Medical Research. 2023;41(6). Kurnianto AA, Khatatbeh H, Prémusz V, Nemeskéri Z, Ágoston I. Managing disabled workers due to occupational accidents in Indonesia: a case study on return to work program. BMC Public Health. 2023 May 24;23(1):943. Soklaridis S, Cassidy JD, van der Velde G, Tompa E, Hogg-Johnson S. The economic cost of return to work: An employer’s perspective. Work. 2012;43(3):255–62. Lammerts L, van Dongen JM, Schaafsma FG, van Mechelen W, Anema JR. A participatory supportive return to work program for workers without an employment contract, sick-listed due to a common mental disorder: an economic evaluation alongside a randomized controlled trial. BMC Public Health. 2017 Dec 2;17(1):162. Macpherson RA, He A, Amick III BC, Koehoorn M, McLeod CB. Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector. Scand J Work Environ Health. 2022 Apr 1;48(3):229–38. Leppink N. Socio-economic costs of work-related injuries and illnesses: Building synergies between Occupational Safety and Health and Productivity. In: The costs of non-safety. 2015. Cole T, Nicks R, Ferris S, Paul E, O’Brien L, Pritchard E. Outcomes after occupational therapy intervention for traumatic brachial plexus injury: A prospective longitudinal cohort study. Journal of Hand Therapy. 2020;33(4). Albert A. Strategies for construction hazard recognition. ProQuest Dissertations and Theses. 2013;(April). Pouliakas K, Theodossiou I. An Inquiry into the Theory, Causes and Consequences of Monitoring Indicators of Health and Safety at Work. SSRN Electronic Journal. 2021; Dol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, et al. Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators. J Occup Rehabil. 2021 Dec 21;31(4):675–98. Aasdahl L, Vasseljen O, Gismervik SØ, Johnsen R, Fimland MS. Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders. J Occup Rehabil. 2021 Dec 25;31(4):721–8. Kurnianto AA, Fehér G, Tololiu KE, Wikurendra EA, Nemeskéri Z, Ágoston I. Analysis of the Return to Work Program for Disabled Workers during the Pandemic COVID-19 Using the Quality of Life and Work Ability Index: Cross-Sectional Study. Int J Environ Res Public Health. 2023 Feb 1;20(4). Savitsky B, Radomislensky I, Goldman S, Gitelson N, Frid Z, Peleg K. Returning to Work Following an Injury: Practical Usage of a Predictive Model Based on a Nationwide Study. J Community Health. 2020 Feb 4;45(1):183–93. Macpherson RA, He A, C AIB, Koehoorn M, McLeod CB. Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector. Scand J Work Environ Health [Internet]. 2022;48(3):229–38. Available from: https://pubmed.ncbi.nlm.nih.gov/34902046/ Walker S, Griffin S, Asaria M, Tsuchiya A, Sculpher M. Striving for a Societal Perspective: A Framework for Economic Evaluations When Costs and Effects Fall on Multiple Sectors and Decision Makers. Appl Health Econ Health Policy. 2019 Oct 16;17(5):577–90. Trueman P, Anokye NK. Applying economic evaluation to public health interventions: the case of interventions to promote physical activity. J Public Health (Bangkok). 2013 Mar 1;35(1):32–9. Lestari F, Sunindijo RY, Loosemore M, Kusminanti Y, Widanarko B. A Safety Climate Framework for Improving Health and Safety in the Indonesian Construction Industry. Int J Environ Res Public Health. 2020 Oct 14;17(20):7462. Loosemore M, Sunindijo RY, Lestari F, Kusminanti Y, Widanarko B. Comparing the safety climate of the Indonesian and Australian construction industries. Engineering, Construction and Architectural Management. 2019 Sep 18;26(10):2206–22. Sessler DI, Imrey PB. Clinical research methodology 2: Observational clinical research. Anesth Analg. 2015;121(4):1043–51. Ghosh B, Bhowmik S, Bandyopadhyay D. Cohort study: design, measures, and classic examples. Translational Cardiology. 2025. 217–220 p. Koutentakis M. Common issues in analysis. Translational Cardiology. 2025. 127–137 p. Trueman P, Anokye NK. Applying economic evaluation to public health interventions: the case of interventions to promote physical activity. J Public Health (Bangkok). 2013 Mar 1;35(1):32–9. Wang Z, Salmon JW, Walton SM. Cost-Effectiveness Analysis and the Formulary Decision-Making Process. Journal of Managed Care Pharmacy. 2004 Jan;10(1):48–59. Xiao H, Augusto O, Wagenaar BH. Reflection on modern methods: A common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3). Bernal JL, Cummins S, Gasparrini A. Erratum: Interrupted time series regression for the evaluation of public health interventions: A tutorial (International Journal of Epidemiology (2017) 46 (348–355) DOI: 10.1093/ije/dyw098). Vol. 49, International Journal of Epidemiology. 2020. Bernal JL, Cummins S, Gasparrini A. Corrigendum to: Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2021;50(3). Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: A tutorial. Int J Epidemiol. 2017;46(1). Wong RH, Smieliauskas F, Pan IW, Lam SK. Interrupted time-series analysis: Studying trends in neurosurgery. Neurosurg Focus. 2015;39(6). Nugraha B, Setyono G, Defi I, Gutenbrunner C. Strengthening rehabilitation services in Indonesia: A brief situation analysis. J Rehabil Med. 2018;50(4):377–84. Johanson S, Gregersen Oestergaard L, Bejerholm U, Nygren C, van Tulder M, Zingmark M. Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scand J Occup Ther. 2023 Nov 17;30(8):1339–56. Soklaridis S, Cassidy JD, van der Velde G, Tompa E, Hogg-Johnson S. The economic cost of return to work: An employer’s perspective. Work. 2012;43(3):255–62. Evensen S, Wisløff T, Lystad JU, Bull H, Martinsen EW, Ueland T, et al. Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry. 2019 Dec 7;19(1):140. Vermeulen SJ, Anema JR, Schellart AJM, Knol DL, Van Mechelen W, Van Der Beek AJ. A participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: Results of a randomized controlled trial. J Occup Rehabil. 2011;21(3):313–24. Waddell G. Is work good for your health and well-being? The Stationary Office. 2006; Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. J Occup Rehabil. 2018 Mar 21;28(1):1–15. ISSA. ISSA Guidelines Return to Work and Reintegration [Internet]. International Social Security Association. 2019. Available from: https://ww1.issa.int/system/files/documents/2020-08/2-Guidelines RTW-2020.pdf Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7311475","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497796728,"identity":"a285fa8f-7cfe-4b28-8074-4419f5907729","order_by":0,"name":"Arie Arizandi 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DEVELOPMENT, PÉCS","correspondingAuthor":false,"prefix":"","firstName":"Zsolt","middleName":"","lastName":"Nemeskéri","suffix":""},{"id":497796733,"identity":"e3810972-d7ef-45ec-81a5-89097c16db8c","order_by":5,"name":"István Ágoston","email":"","orcid":"","institution":"UNIVERSITY OF PÉCS, DOCTORAL SCHOOL OF HEALTH SCIENCES, PÉCS","correspondingAuthor":false,"prefix":"","firstName":"István","middleName":"","lastName":"Ágoston","suffix":""}],"badges":[],"createdAt":"2025-08-06 15:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7311475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7311475/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89972672,"identity":"dbcf4763-cabe-41e8-8b92-461592363bf2","added_by":"auto","created_at":"2025-08-27 05:47:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26680,"visible":true,"origin":"","legend":"\u003cp\u003eModel of RTW program : component and outcomes\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/4e9c79d2a418d47bacef0dea.png"},{"id":89972671,"identity":"02eb4323-5477-4a4f-9137-77ceb4877e47","added_by":"auto","created_at":"2025-08-27 05:47:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":68769,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRegional Case Distribution\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/647f0d3f0c0d44d5358f80b9.png"},{"id":89972674,"identity":"d5fa00d1-6c11-4035-b3b9-4340393f4024","added_by":"auto","created_at":"2025-08-27 05:47:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":193558,"visible":true,"origin":"","legend":"\u003cp\u003eCost Component Distribution\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/78cbe2aa51b75d2e0507ac74.png"},{"id":89972675,"identity":"b70cdf63-4ee3-4167-a912-522953ffee04","added_by":"auto","created_at":"2025-08-27 05:47:12","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":30424,"visible":true,"origin":"","legend":"\u003cp\u003eMedical Cost Distribution\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/8063f32c20477ecb764febe6.png"},{"id":89972673,"identity":"9c9ae53a-4302-470d-9ce4-65759a8c47ed","added_by":"auto","created_at":"2025-08-27 05:47:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":93900,"visible":true,"origin":"","legend":"\u003cp\u003eProductivity Loss Comparison\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/8cb04443af2ee9f75b8768bc.png"},{"id":89974780,"identity":"bac81f46-bfce-486f-a23f-4c5a284c841e","added_by":"auto","created_at":"2025-08-27 05:55:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1603225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7311475/v1/4fcb193f-4c49-4cd5-ba8d-fd4581af4073.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCost-Consequence Analysis of Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOccupational injuries have a significant economic and social impacts, particularly in developing nations where Return To Work (RTW) programs are limited (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The Return to Work (RTW) program in Indonesia is administered by BPJS Ketenagakerjaan, the national social security agency, is a formalized rehabilitation and return to work program to assist workers who have sustained a work-related injury and are disabled, to return to gainful employment (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Moreover, RTW program was formed nationally in 2015, to provide a formalized RTW program that integrates medical treatment, vocational rehabilitation, prosthetics and orthotics, workplace adaptation, and psychosocial support. In addition, RTW services could begin as early as when workers have reported their on-the-job injury, followed by a medical assessment and rehabilitation plan, and all support is to be coordinated among the RTW coordinator (case manager), the healthcare provider, and the employer. Workers that present must be in the diagnosis of partial or total permanent disability as a result of a workplace occupational accident or commuting injury (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The goals of the RTW program are to promote capacity building to restore functional capacity, decrease the number of lost workdays, and decrease the social and economic burden associated with work disability (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In fact, in 2021, Indonesia recorded 234,370 work accidents and work-related diseases, including 6,565 cases in the mining sector (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). While RTW programs have existed in developed countries for several years, Indonesia only introduced its RTW program in 2015 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and evidence of its effectiveness remains limited, particularly in terms of economic and productivity outcomes.\u003c/p\u003e\u003cp\u003eIn addition, the costs and consequences borne by social security providers, employers, and disabled workers, especially those with occupational injuries, managed in RTW program have not received much attention (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Severe injuries can lead to permanent disability, loss of income, and a decline in overall quality of life (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, occupational accidents impose significant financial burdens on employers and the healthcare system due to increased medical claims, loss of productivity, and higher insurance costs (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Implementing an effective RTW program can be an important strategy for reducing the costs of workplace injuries for both workers and employers. A structured rehabilitation and reintegration program improves recovery outcomes and supports the successful return of injured workers to employment (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, disabled workers participated in RTW program are more likely to regain purpose and reduce the risk of long term incapacity due to continued access to medical treatment and rehabilitation, which advances complete health results and decreases complications (\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Furthermore, the most significant advantages of RTW program is its function in reducing prolonged impairment or Lost Time Injury Days (LTIDs) through enhanced physical rehabilitation (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Although the path to recuperation varies by way of person, early intervention and a collaborative technique between all events usually yield the finest outcomes for maintaining disabled staff participating within the workforce, which leads to lower turnover rates, saving on recruitment and training costs, and contributes to maintaining high levels of productivity. Additionally, the outcomes of RTW program aligns with Indonesia's broader efforts to meet the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), and SDG 10 (Reduced Inequalities) by promoting the reintegration of disabled workers back into the labor force, the program not only aims to improve health outcomes but also contributes to economic progress and social inclusion.\u003c/p\u003e\u003cp\u003eThe main objective of this study is to assess the economic impact and productivity outcomes of the RTW program in Indonesia. Specifically, this study examines the impact of the RTW program on Lost Time Injury Days (LTIDs), medical care costs, and the productivity outcomes of disabled workers returning to the labor market. This assessment critically reviews the impact of the RTW program, aiming not only help workers who want to return to the workforce, but also to support the mitigation of the economic impact of work accidents. Therefore, this study adopts a cost-consequence analysis (CCA) approach to investigate economic and social outcomes, providing a holistic view of the potential impact of RTW programs in developing countries.\u003c/p\u003e\u003cp\u003eIn regard, cost-consequence analysis (CCA) offers a framework for thoroughly assessing the economic and social impact of RTW programs (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The approach of this study covers multiple dimensions including the health outcome, economic benefits and productivity improvements that result from RTW program. Occupational safety remains a major concern in most developing countries, including Indonesia (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Using these outcomes, we would like to give perspective both the policy maker and other stakeholders with valuable information for future decision making.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThis study used a retrospective observational design that is useful for understanding the epidemiology and impact of health(23–25). Moreover, the cost-consequence analysis (CCA) methodology was used representing a broad range of economic (direct costs, savings), health (Lost Time Injury Days, LTIDs) and productivity (return-to-work rates) outcomes in disaggregated form rather than synthesized to one ratio. This approach allows to conduct a thorough assessment of the emerging effects in different areas related to the program.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eData sources and sampling strategy\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe study recruited workers who experienced an occupational injury resulting in disability. To qualify, participants must have finished either the RTW program or usual care from 2012 to 2022, with closed claims by August 2022. Only those with terminated claims, undergoing treatment under the coverage of social security by BPJS Ketenagakerjaan (Indonesian National Social Security Agency on Employment) and injuries inducing disability were incorporated. This methodology made certain the analysis exclusively evaluated instances where the RTW program could perceptibly impact health results, economic consequences, and productivity measures. Varied workers experienced different recoveries, some struggled for months with pain and diminished function while others adapted well despite the challenges. The program aimed to speed healing and restore independence through accommodations, counseling, and early return considering individual circumstances and limitations.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eCost-Consequence Analysis (CCA) Framework\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe Cost-Consequence Analysis framework employed in this research separated the appraisal of expenses and results into three critical classes: medical impacts, financial results, and profitability outcomes (26,27). This study independently exhibited every one of these results for both the RTW program and standard consideration, empowering choice producers to freely examine the expenses and advantages of each alternative. While the RTW program demonstrated higher expenses, it created considerably more noteworthy wellbeing and profitability yields than conventional treatment. The choice to receive the RTW program ought to rely upon how policymakers’ weight these contrasting expense and result measurements.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eCosts\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eMedical care costs vary considerably across recovery methods. This includes all expenses associated with surgery, rehabilitation, and follow-ups. Costs will be meticulously calculated for both rapid return-to-work and standard care groups in Indonesian Rupiah (IDR) then converted to American dollars (USD). Moreover, Lost time from work due to injuries or lost time injury days (LTIDs), differs dramatically between approaches. Calculating the economic impact of these absent days allows an assessment of delayed recovery's financial toll for both groups.\u003c/p\u003e\n\u003cp\u003eEmployer costs change substantially depending on the recovery method used. The study will examine reductions in absenteeism, disability claims, and temporary replacements, comparing savings between rapid return-to-work and standard care to determine the approach's fiscal influence.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe primary outcome involves the return-to-work percentage, showing the portion of workers successfully reintegrating after the rapid program versus standard care. Additionally, reduced lost time injury days serve as a proxy for improved well-being, with fewer absent days signifying swifter healing and more effective rehabilitation.\u003c/p\u003e\n\u003cp\u003eProductivity outcomes will be assessed by analyzing reduced lost time injury days and economic contributions from active employees. Faster re-employment progress expected yields massive productivity increases, compared between the rapid and standard care groups.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe Cost-Consequence Analysis (CCA) will involve a direct comparison of costs and outcomes between the RTW program and usual care. Descriptive statistics will be used to summarize the costs (e.g., medical expenses, LTIDs) and outcomes (e.g., return-to-work rates, productivity gains) for each group. The research was conducted with retrospective observational design, comparing pre- and post-implementation RTW policies for occupational injuries necessitating surgery. We compiled data on the quantity of LTIDs and medical expenditures for job-associated injuries necessitating surgery across a decade. It proves particularly useful for scrutinizing the impacts of policy changes, for instance enactment of a RTW initiative(28–32). Some cases necessitated prolonged recovery or rehabilitation, creating higher costs than anticipated. However, other cases saw workers able to return to employment sooner than forecasted due to supportive RTW accommodations, offsetting some expenses. Overall, the analysis aimed to discern the complex influences of RTW policies on various outcomes over an extended time horizon.\u003c/p\u003e\n\u003cp\u003eIn our study, the inclusion criteria of eligible cases were determined and included in the analysis if relevant regarding the effectiveness of RTW programs for occupational injury cases. The first inclusion criterion was that the case was a work injury that resulted in partial anatomical disability, partial functional disability, or total permanent disability. Then, the case was handled by a provider with an occupational accident and RTW insurance coverage program; and the case was closed. From the screened claims, 10,602 cases received usual care, while 1,353 cases received the RTW program.\u003c/p\u003e\n\u003cp\u003eMoreover, we compared LTIDs and medical treatment costs between usual care and RTW program claims using segmentation analysis to assess the effectiveness of the RTW program. This analysis allowed us to model the trend in cost consequences of the usual care intervention in the outcome variable and estimate the change in trend after the RTW program intervention. We also used graphical representations, to visually assess trends in the distribution of components of each type of care.\u003c/p\u003e\n\u003cp\u003eFurthermore, we used a graphical representation, to visually assess trends in the distribution of components of each treatment type. In addition, we included covariates such as age, gender, distribution of cases within the coverage area and industry sector to address potential confounding variables and ensure the accuracy of the analysis. Statistical software, including SPSS version 25.0, was used to conduct comprehensive data analysis, and a significance level of p \u0026lt; 0.05 was set. R Studio version 4.2.2 was used for data visualization purposes.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eEthics\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThis study has received ethical approval from the Health Research Ethics Committee, Faculty of Public Health, Universitas Airlangga, with number: 58/EA/KEPK/2021. This study has been deemed to meet ethical criteria based on 7 (seven) WHO Standards 2011, in accordance with the 2016 CIOMS Guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, the results of the descriptive analysis are presented in Table 1. A comprehensive understanding of the pattern of occupational injuries across several subgroups of workers can be depicted in the descriptive statistical analysis for each category. Moreover, valuable insights into the nature and extent of occupational injuries were gained from the findings of the descriptive analysis, which can be used to inform and guide injury prevention and management strategies.\u003c/p\u003e\n\u003cp\u003eA total of 11,955 injured workers were observed, comprising 1,353 participants enrolled in the RTW program and 10,602 who received usual care. In this study, 11,955 claims of workers injured in work accidents were observed, consisting of 1,353 participants enrolled in the RTW program and 10,602 who received usual care. The baseline characteristics are outlined in \u003cstrong\u003eTable 1\u003c/strong\u003e, along with attributes such as age, gender, and industry sector. The participants\u0026apos; mean age was 34.5 years with a standard deviation of 6.1 years in the RTW group and 35.3 years with a standard deviation of 5.8 years in the usual care group - a non-significant difference between the two. Moreover, most of the participants in both categories were male, at 86% of the RTW group and 87% of the usual care group. Furthermore, industry domains included manufacturing, agriculture, and transport, with comparable distribution across the two groups. This study also presents an exploration of the model of RTW program implemented in Indonesia within the scope of social security employment (\u003cstrong\u003eFigure 1)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eBased on the regional distribution \u003cstrong\u003e(Figure 2)\u003c/strong\u003e, there are significant disparities (p\u0026lt;0.001) in participant distribution between RTW Program and Usual Care across most regions in Indonesia. The most notable differences are observed in three key regions: West Java shows a substantially higher representation in the RTW Program (22.4% vs 9.2%), while Central Java has a markedly higher proportion in Usual Care (29.1% vs 16.9%). Northern Sumatra also shows considerable variation (19.3% in Usual Care vs 12.9% in RTW Program). Only three regions - East Java (p=0.547), Banten (p=0.642), and East Indonesia (p=0.234) - show no statistically significant differences between the two programs, suggesting more balanced participation rates in these areas. This regional variation highlights potential geographical disparities in program implementation and accessibility across Indonesia\u0026apos;s different regions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Baseline Sample Characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRTW Program (n = 1,353)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsual Care (n = 10,602)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory of age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Age (mean, SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e34.0 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35.0 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; 15-24 y.o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; 25-54 y.o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e73.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e76.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026ge; 55 y.o\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e86.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e87.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Female\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Successful\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Unsuccessful\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e79.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndustry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Manufactures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Agriculture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Mining\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Animal husbandry/Fisheries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Transportation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Unspecified Industries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Partly Anatomical Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Partly Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Total Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation of Accident\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; At work\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e65.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Commuting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; Outside\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003enotes:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eValues are presented as mean (SD) for continuous variables and percentages for categorical variables\u003c/li\u003e\n \u003cli\u003ep-values were calculated using t-tests for continuous variables and chi-square tests for categorical variables\u003c/li\u003e\n \u003cli\u003eStatistical significance was set at p \u0026lt; 0.05\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cem\u003eFinancial Breakdown of Cost Elements\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eAnalysis of cost components, as shown in \u003cstrong\u003eFigure 3\u003c/strong\u003e, reveals substantial differences between the RTW program and usual care approaches. Direct medical costs in the RTW program averaged $822.50 per case, compared to $262.25 in usual care, reflecting the intensive initial investment in comprehensive rehabilitation. However, rehabilitation services costs ($212.73 vs $42.19) and prosthetic/orthotic devices costs ($418.64 vs $278.45) demonstrated more efficient resource utilization in the RTW program despite higher initial investments.\u003c/p\u003e\n\u003cp\u003eThe second major cost component analysis shows that transportation costs ($36.98 vs $10.10) and disability compensation ($1,832.13 vs $1,133.10) were higher in the RTW program initially. However, these higher upfront costs were offset by significantly reduced lost workdays (350.3 days vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20), indicating better economic efficiency in the RTW program over time.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eEconomic Impact and Effectiveness Analysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe comprehensive cost-consequence analysis presented in \u003cstrong\u003eTable 3\u003c/strong\u003e demonstrates the superior economic efficiency of the RTW program compared to usual care. The total direct costs, including medical treatment, rehabilitation, prosthetics/orthotics, and transportation, amounted to $1,246.28 per case in the RTW program compared to $392.28 in usual care. However, when considering the broader economic impact, including productivity losses, the RTW program showed a more favorable total cost profile ($47,485.88 vs $28,653.48), primarily due to its effectiveness in reducing lost workdays and improving return-to-work outcomes.\u003c/p\u003e\n\u003cp\u003eFurther analysis of cost-effectiveness reveals that the cost per LTID (Lost Time Injury Day) was comparable between the two approaches ($135.56 vs $133.83), but the RTW program achieved significantly better outcomes. The most striking difference was observed in the return-to-work rates, where the RTW program achieved an 84.0% success rate compared to 20.3% in usual care, representing a substantial 63.7% improvement. This difference, combined with the cost analysis, suggests that while the RTW program requires higher initial investment, it provides better value for money through improved outcomes and long-term cost savings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Variable description\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable Name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical Treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eDirect medical costs including consultations, procedures, and medications for injury treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRehabilitation Services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eSpecialized rehabilitation services including physical therapy and recovery programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProsthetics Orthotic Devices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eCosts for artificial limbs, support devices, and assistive technologies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransportation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003ePatient transportation expenses for medical visits and treatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisability Compensation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eFinancial compensation provided during disability period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Direct Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eAggregate of all medical, rehabilitation, prosthetic, and transportation costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLTIDs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal number of work days lost due to injury/disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDays\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTime Measure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProductivity Loss Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eEconomic value of productivity lost during disability period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eIndirect Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Cost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eSum of all direct costs and productivity loss costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal Cost\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost per LTIDs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal cost divided by number of lost time injury days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eUSD per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eCost Efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRTW Rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003ePercentage of workers who successfully returned to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eOutcome Measure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e Cost Consequences Analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCost Component\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRTW Program\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsual Care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference (RTW - Usual)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA. Direct Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;1. Medical treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$822.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$262.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$560.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;2. Rehabilitation services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$212.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$42.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$170.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;3. Prosthetic/Orthotic devices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$418.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$278.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$140.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;4. Transportation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$36.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$10.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$26.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;5. Disability compensation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$1,832.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$1,133.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$699.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB. Total Direct Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$1,246.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$392.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$854.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC. Indirect Costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;1. Lost Time Injury Days (LTIDs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e350.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e214.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e136.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;2. Productivity loss costs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$46,239.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$28,261.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$17,978.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD. Total Costs (B + C2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$47,485.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$28,653.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$18,832.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. Cost per LTID day (D/C1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e$135.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e$133.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e$1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF. Return to Work Rate (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMoreover, the boxplot in \u003cstrong\u003eFigure 4\u003c/strong\u003e illustrates the distribution of medical costs between the RTW Program and Usual Care groups. The RTW Program shows a higher median cost, with the box (interquartile range) extending from approximately USD 425 to USD 550, and a median around USD 500. The whiskers extend from about USD 250 to USD 750, with several outliers above USD 800 and below USD 200, indicating some cases with exceptionally high or low medical costs.\u003c/p\u003e\n\u003cp\u003eIn comparison, the Usual Care group demonstrates lower overall costs, with a median around USD 400, and an interquartile range from approximately USD 350 to USD 450. The whiskers for this group extend from about USD 200 to USD 600, with some outliers reaching up to USD 700. This distribution suggests that while the RTW Program generally incurs higher medical costs, it also shows greater variability in cost distribution, potentially reflecting a more individualized and comprehensive approach to medical care. The presence of outliers in both groups indicates that some cases required significantly more medical resources than typical, regardless of the program type.\u003c/p\u003e\n\u003cp\u003eAnnual and cumulative productivity loss comparisons show significantly lower productivity losses over time for RTW participants compared with usual care cases. As presented in \u003cstrong\u003eFigure 5\u003c/strong\u003e, the annual productivity loss of participants\u0026ensp;from the RTW program was consistently lower over years, confirming the economic validity of the program. Moreover\u003cstrong\u003e, Figure 5\u003c/strong\u003e illustrates the cumulative trends in productivity losses and shows that RTW interventions reduce long\u0026ensp;new economy burdens related to lost work capacity. These findings highlight\u0026ensp;the significance of structured RTW programmes capable of improving workforce sustainability and relieving the financial burden on the social security system.\u003c/p\u003e"},{"header":"Discussion","content":"\u003ch2\u003e\u003cem\u003eRegional Disparities and Program Accessibility\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThere is a notable disparity between urban and rural areas in terms of program accessibility and outcomes. Urban areas, particularly densely populated industrial regions, tend to have better access to RTW services and higher participation rates. Moreover, there are\u0026nbsp;many hospitals, especially in rural areas, lack medical rehabilitation facilities required for the RTW program (6). Additionally, the geographical challenges posed by Indonesia's archipelagic nature, with over 13,000 islands, create significant barriers to accessing health services, including rehabilitation (33).\u003c/p\u003e\n\u003cp\u003eFurthermore, there is an uneven distribution of rehabilitation professionals across the country, such as most rehabilitation professionals are concentrated in large cities, leaving rural and remote areas underserved(33). The ratios of Physical and Rehabilitation Medicine (PRM) specialists, physiotherapists, and occupational therapists per million population in Indonesia are significantly lower than in high-income countries (33).\u003c/p\u003e\n\u003cp\u003eTherefore, to address this gap, it is critical to maximize program impact and ensure that all workers, regardless of location, can benefit from comprehensive rehabilitation and support. Strategies to improve the accessibility of the program may include expanding the network of health providers in underserved areas, particularly focusing on medical rehabilitation facilities. In addition, implementing strategies to improve the distribution of rehabilitation professionals across the country. Equally important is improving coordination between the various ministries responsible for disability and rehabilitation services.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eEconomic Efficiency\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe economic efficiency and cost-effectiveness analysis in this study of the Return to Work (RTW) program in Indonesia offers some unique insights compared to other studies in the field of occupational rehabilitation. Unlike many studies that focus solely on direct medical costs or short-term outcomes, this research provides a comprehensive cost-consequence analysis that considers both direct and indirect costs, as well as long-term productivity gains.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study found that while the RTW program had higher initial costs ($822.50 per case compared to $262.25 for usual care), it demonstrated superior economic efficiency over time due to significantly reduced lost workdays (350.3 days vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20). This aligns with findings from other studies, such as those on Individual Placement and Support (IPS) interventions, which often show higher initial costs but better long-term outcomes(34). However, this study goes further by providing a detailed breakdown of various cost components and their distribution, offering a more nuanced understanding of where investments yield the greatest returns. The study's focus on a developing country context also sets it apart from many existing studies, which often concentrate on high-income countries (35,36). Furthermore, the inclusion of regional disparities in program implementation adds a valuable dimension not commonly addressed in other economic evaluations of RTW programs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, based on our findings that trends indicate that the need for structured RTW programs to improvement workforce sustainability. RTW participants may face higher medical costs in the early months, but overall productivity gains and decreased disability claims more than compensate for the upfront investment — a strong economic case for sustained investment in RTW. In addition, study found that a participatory program for RTW for workers with musculoskeletal disorders led to a significant reduction of time to sustainable RTW in comparison to usual care(37). Policymakers and stakeholders may want to expand RTW access and refine program execution to capture these economic and social dividends.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eImplications for Rehabilitation and Workforce Reintegration\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe RTW program's emphasis on a comprehensive approach that addresses medical, psychological, and social needs of injured workers aligns with findings from other research, such as highlighted the importance of re-orienting health services towards maintaining employment (38). The program's effectiveness in early intervention is consistent with other study, which found that early implementation of vocational rehabilitation showed modest effectiveness on work participation (39). Furthermore, the economic benefits demonstrated by the RTW program, despite higher initial costs, are in line with findings from the International Social Security Association (ISSA) study, which showed significant returns on investment for work reintegration measures (40).\u003c/p\u003e\n\u003cp\u003eHowever, this study offers unique insights that set it apart from existing literature. The analysis of regional disparities in program implementation and accessibility is not commonly addressed in other economic evaluations of RTW programs. This aspect provides valuable information on the challenges of implementing such programs across diverse geographical areas, particularly in a developing country context. Additionally, the study's comprehensive cost-consequence analysis, which considers both direct and indirect costs as well as long-term productivity gains, offers a more nuanced understanding of the program's economic impact compared to many other studies that focus solely on direct medical costs or short-term outcomes. These unique contributions make this study a valuable addition to the existing body of knowledge on occupational rehabilitation interventions, particularly in the context of developing countries.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe implementation of the RTW program by BPJS Ketenagakerjaan has proven to be an effective strategy for reintegrating workers with disabilities resulting from occupational injuries into the workforce. The program not only enhances return-to-work rates but also offers a more economical solution compared to usual care, with better outcomes.\u003c/p\u003e\n\u003cp\u003eThis study also highlighted RTW program outreach and equitable access across regions can increase the impact of the program. Long-term research should center on determining the exact parts of the RTW program that contribute most to its success, and explore approaches to optimize these factors for different local situations. In addition, long-term research could provide a deeper understanding of the long-term benefits of RTW programs, particularly in relation to sustained productivity gains and improved quality of life for employees with disabilities. Considering these areas, future analysis can help refine and expand the RTW program, which in turn can contribute to a more resilient and inclusive employment policy in Indonesia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their appreciation to the BPJS Ketenagakerjaan, Indonesian Social Security Agency on Employment, for sharing the data used in this study. We acknowledge that a previous iteration of this study was submitted as a thesis in order to fulfil the criteria for a PhD in Health Sciences at the University of P\u0026eacute;cs. We are grateful for the chance to improve and broaden this study for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubstantial contributions to the conception or design of the work: \u003cstrong\u003eKurnianto\u003c/strong\u003e, the acquisition, analysis, or interpretation of data for the work: \u003cstrong\u003eKurnianto, Putri, Paranata.\u0026nbsp;\u003c/strong\u003eDrafting the work or revising it critically for important intellectual content: \u003cstrong\u003eKurnianto, Amer, Putri, Paranata\u003c/strong\u003e. Final approval of the version to be published: \u003cstrong\u003eAmer, Nemesk\u0026eacute;ri, \u0026Aacute;goston\u003c/strong\u003e. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: \u003cstrong\u003eKurnianto, Nemesk\u0026eacute;ri, \u0026Aacute;goston.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has received ethical approval from the Health Research Ethics Committee, Faculty of Public Health, Universitas Airlangga, with number: 58/EA/KEPK/2021. This study has been deemed to meet ethical criteria based on 7 (seven) WHO Standards 2011, including social value, scientific validity, fair subject selection, risk reduction, independent review, clear informed consent, and respect for the privacy and confidentiality of participants, in accordance with the 2016 CIOMS Guidelines. Fulfillment of the indicators for each standard also indicates the study\u0026apos;s compliance with these ethical requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflict of interest that the authors have to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number`\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZdanovsky V, Radionov M, Sepitchak V, Soltysik R. THE USE OF A RISK-ORIENTED APPROACH OF PRODUCTION FACTORS ASSESSMENT FOR INCREASING THE EFFICIENCY OF OCCUPATIONAL SAFETY MANAGEMENT SYSTEM. Bulletin of Lviv State University of Life Safety. 2022;24. \u003c/li\u003e\n\u003cli\u003eLeigh JP. Economic burden of occupational injury and illness in the United States. Milbank Quarterly. 2011;89(4). \u003c/li\u003e\n\u003cli\u003eAdei D, Agyemang-Duah W, Mensah AA. Demographic and socio-economic factors associated with exposure to occupational injuries and diseases among informal sector workers in Kumasi metropolis, Ghana. Journal of Public Health (Germany). 2022;30(9). \u003c/li\u003e\n\u003cli\u003eQuinn MM, Markkanen PK, Galligan CJ, Sama SR, Lindberg JE, Edwards MF. Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides. Vol. 8, Current Environmental Health Reports. 2021. \u003c/li\u003e\n\u003cli\u003eSultan M. Collaboration Tripartite Elements Accident Reporting and Potential Hazards Management Coal Mining, Indonesia: Systematic Review. Journal of Health Science and Medical Research. 2023;41(6). \u003c/li\u003e\n\u003cli\u003eKurnianto AA, Khatatbeh H, Pr\u0026eacute;musz V, Nemesk\u0026eacute;ri Z, \u0026Aacute;goston I. Managing disabled workers due to occupational accidents in Indonesia: a case study on return to work program. BMC Public Health. 2023 May 24;23(1):943. \u003c/li\u003e\n\u003cli\u003eSoklaridis S, Cassidy JD, van der Velde G, Tompa E, Hogg-Johnson S. The economic cost of return to work: An employer\u0026rsquo;s perspective. Work. 2012;43(3):255\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eLammerts L, van Dongen JM, Schaafsma FG, van Mechelen W, Anema JR. A participatory supportive return to work program for workers without an employment contract, sick-listed due to a common mental disorder: an economic evaluation alongside a randomized controlled trial. BMC Public Health. 2017 Dec 2;17(1):162. \u003c/li\u003e\n\u003cli\u003eMacpherson RA, He A, Amick III BC, Koehoorn M, McLeod CB. Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector. Scand J Work Environ Health. 2022 Apr 1;48(3):229\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eLeppink N. Socio-economic costs of work-related injuries and illnesses: Building synergies between Occupational Safety and Health and Productivity. In: The costs of non-safety. 2015. \u003c/li\u003e\n\u003cli\u003eCole T, Nicks R, Ferris S, Paul E, O\u0026rsquo;Brien L, Pritchard E. Outcomes after occupational therapy intervention for traumatic brachial plexus injury: A prospective longitudinal cohort study. Journal of Hand Therapy. 2020;33(4). \u003c/li\u003e\n\u003cli\u003eAlbert A. Strategies for construction hazard recognition. ProQuest Dissertations and Theses. 2013;(April). \u003c/li\u003e\n\u003cli\u003ePouliakas K, Theodossiou I. An Inquiry into the Theory, Causes and Consequences of Monitoring Indicators of Health and Safety at Work. SSRN Electronic Journal. 2021; \u003c/li\u003e\n\u003cli\u003eDol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, et al. Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators. J Occup Rehabil. 2021 Dec 21;31(4):675\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eAasdahl L, Vasseljen O, Gismervik S\u0026Oslash;, Johnsen R, Fimland MS. Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders. J Occup Rehabil. 2021 Dec 25;31(4):721\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKurnianto AA, Feh\u0026eacute;r G, Tololiu KE, Wikurendra EA, Nemesk\u0026eacute;ri Z, \u0026Aacute;goston I. Analysis of the Return to Work Program for Disabled Workers during the Pandemic COVID-19 Using the Quality of Life and Work Ability Index: Cross-Sectional Study. Int J Environ Res Public Health. 2023 Feb 1;20(4). \u003c/li\u003e\n\u003cli\u003eSavitsky B, Radomislensky I, Goldman S, Gitelson N, Frid Z, Peleg K. Returning to Work Following an Injury: Practical Usage of a Predictive Model Based on a Nationwide Study. J Community Health. 2020 Feb 4;45(1):183\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eMacpherson RA, He A, C AIB, Koehoorn M, McLeod CB. Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector. Scand J Work Environ Health [Internet]. 2022;48(3):229\u0026ndash;38. Available from: https://pubmed.ncbi.nlm.nih.gov/34902046/\u003c/li\u003e\n\u003cli\u003eWalker S, Griffin S, Asaria M, Tsuchiya A, Sculpher M. Striving for a Societal Perspective: A Framework for Economic Evaluations When Costs and Effects Fall on Multiple Sectors and Decision Makers. Appl Health Econ Health Policy. 2019 Oct 16;17(5):577\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eTrueman P, Anokye NK. Applying economic evaluation to public health interventions: the case of interventions to promote physical activity. J Public Health (Bangkok). 2013 Mar 1;35(1):32\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLestari F, Sunindijo RY, Loosemore M, Kusminanti Y, Widanarko B. A Safety Climate Framework for Improving Health and Safety in the Indonesian Construction Industry. Int J Environ Res Public Health. 2020 Oct 14;17(20):7462. \u003c/li\u003e\n\u003cli\u003eLoosemore M, Sunindijo RY, Lestari F, Kusminanti Y, Widanarko B. Comparing the safety climate of the Indonesian and Australian construction industries. Engineering, Construction and Architectural Management. 2019 Sep 18;26(10):2206\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eSessler DI, Imrey PB. Clinical research methodology 2: Observational clinical research. Anesth Analg. 2015;121(4):1043\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eGhosh B, Bhowmik S, Bandyopadhyay D. Cohort study: design, measures, and classic examples. Translational Cardiology. 2025. 217\u0026ndash;220 p. \u003c/li\u003e\n\u003cli\u003eKoutentakis M. Common issues in analysis. Translational Cardiology. 2025. 127\u0026ndash;137 p. \u003c/li\u003e\n\u003cli\u003eTrueman P, Anokye NK. Applying economic evaluation to public health interventions: the case of interventions to promote physical activity. J Public Health (Bangkok). 2013 Mar 1;35(1):32\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eWang Z, Salmon JW, Walton SM. Cost-Effectiveness Analysis and the Formulary Decision-Making Process. Journal of Managed Care Pharmacy. 2004 Jan;10(1):48\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eXiao H, Augusto O, Wagenaar BH. Reflection on modern methods: A common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3). \u003c/li\u003e\n\u003cli\u003eBernal JL, Cummins S, Gasparrini A. Erratum: Interrupted time series regression for the evaluation of public health interventions: A tutorial (International Journal of Epidemiology (2017) 46 (348\u0026ndash;355) DOI: 10.1093/ije/dyw098). Vol. 49, International Journal of Epidemiology. 2020. \u003c/li\u003e\n\u003cli\u003eBernal JL, Cummins S, Gasparrini A. Corrigendum to: Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2021;50(3). \u003c/li\u003e\n\u003cli\u003eBernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: A tutorial. Int J Epidemiol. 2017;46(1). \u003c/li\u003e\n\u003cli\u003eWong RH, Smieliauskas F, Pan IW, Lam SK. Interrupted time-series analysis: Studying trends in neurosurgery. Neurosurg Focus. 2015;39(6). \u003c/li\u003e\n\u003cli\u003eNugraha B, Setyono G, Defi I, Gutenbrunner C. Strengthening rehabilitation services in Indonesia: A brief situation analysis. J Rehabil Med. 2018;50(4):377\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eJohanson S, Gregersen Oestergaard L, Bejerholm U, Nygren C, van Tulder M, Zingmark M. Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scand J Occup Ther. 2023 Nov 17;30(8):1339\u0026ndash;56. \u003c/li\u003e\n\u003cli\u003eSoklaridis S, Cassidy JD, van der Velde G, Tompa E, Hogg-Johnson S. The economic cost of return to work: An employer\u0026rsquo;s perspective. Work. 2012;43(3):255\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eEvensen S, Wisl\u0026oslash;ff T, Lystad JU, Bull H, Martinsen EW, Ueland T, et al. Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry. 2019 Dec 7;19(1):140. \u003c/li\u003e\n\u003cli\u003eVermeulen SJ, Anema JR, Schellart AJM, Knol DL, Van Mechelen W, Van Der Beek AJ. A participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: Results of a randomized controlled trial. J Occup Rehabil. 2011;21(3):313\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eWaddell G. Is work good for your health and well-being? The Stationary Office. 2006; \u003c/li\u003e\n\u003cli\u003eCullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. J Occup Rehabil. 2018 Mar 21;28(1):1\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eISSA. ISSA Guidelines Return to Work and Reintegration [Internet]. International Social Security Association. 2019. Available from: https://ww1.issa.int/system/files/documents/2020-08/2-Guidelines RTW-2020.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Cost-Consequences Analysis, Return To Work, Disability, Occupational Accidents","lastPublishedDoi":"10.21203/rs.3.rs-7311475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7311475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: This study aims to address the challenge of Return To Work program by evaluating the cost consequences of the implementation of RTW program. Therefore, the principal research question is whether the RTW program produces better health outcomes, health costs, and productivity loss compared to standard care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective observational study was conducted by using occupational injury claims from 2012 to August 2022. The study included 11,955 claims, with 1,353 identified as RTW cases and 10,602 as non-RTW cases. Outcome measures included Lost Time Injury Days (LTIDs), the RTW rates, and the efficiency of medical care expenses. A cost-consequence analysis was performed to assess the economic and productivity impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThere was a significant difference between the RTW and non-RTW groups in terms of LTIDs (p \u0026lt; 0.001) and labor market outcomes (p \u0026lt; 0.001). The RTW program showed higher initial costs ($822.50 per case vs $262.25) but demonstrated superior economic efficiency over time due to reduced lost workdays (350.3 vs 214.1 days) and lower long-term productivity loss costs ($46,239.60 vs $28,261.20).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The Return To Work (RTW) program works to reintegrate workers into the workforce while also providing significant economic benefit. Future studies could also analyze how productivity growth differs across geographical regions.\u003c/p\u003e","manuscriptTitle":"Cost-Consequence Analysis of Return to Work (RTW) Program for Workers with Disabilities in Indonesia: Health, Economic and Productivity Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 05:47:07","doi":"10.21203/rs.3.rs-7311475/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-08T15:36:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-08T07:28:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T07:26:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Occupational Rehabilitation","date":"2025-08-06T15:47:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joor","sideBox":"Learn more about [Journal of Occupational Rehabilitation](https://www.springer.com/journal/10926)","snPcode":"10926","submissionUrl":"https://submission.nature.com/new-submission/10926/3","title":"Journal of Occupational Rehabilitation","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3e223c48-9ff9-458d-a828-e45e42df2941","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-11T16:24:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 05:47:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7311475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7311475","identity":"rs-7311475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}