Musculoskeletal conditions contribute to more than 30 million sickness absence days per year in the UK, costing British employers £5.6 billion. Although yoga can be effective for managing musculoskeletal conditions, there is little evidence demonstrating its cost-effectiveness for employers. This thesis explores the cost-effectiveness of yoga in workplace settings using five methods of economic evaluation and taking a broad approach recommended by the NICE Centre for Public Health Excellence (chapter 1).
A comprehensive literature review found no published studies on the cost-effectiveness of yoga in workplace settings. Therefore, a systematic review was conducted, which reported promising yet limited evidence for the effectiveness of yoga in the workplace (chapter 2).
A randomised controlled trial (n=151) was designed and implemented, comparing yoga with usual care at three hospital sites in North Wales. At end-programme, results showed that yoga generated statistically significant reductions in back pain and improvements in psychological wellbeing (chapter 3). Additional outcomes included enhanced physical flexibility, better posture, improved sleep quality and greater body awareness (chapter 4).
Four scenarios were created in a costing analysis (chapter 5). A cost-consequence analysis compared each scenario with a range of disaggregated outcomes using employer, healthcare and societal perspectives (chapter 6).
From a healthcare perspective, cost-effectiveness analysis reported incremental cost-effectiveness ratios (ICERs) ranging from £21 to £114 per one point reduction in back pain (RDQ) with the probability of cost-effectiveness ranging from 75% to 78% using a threshold of £1,300 (chapter 7). Cost-utility analysis indicated ICERs ranging from £317 to £1,756 per quality-adjusted life year (QAL Y) with the probability of cost-effectiveness ranging from 87% to 92% using a £20,000 per QAL Y threshold (chapter 8).
From an employer perspective, return on investment analysis showed that yoga was cost saving with a benefit-cost ratio of 1.35 when yoga instructors were paid £64 per session. With a co-payment scheme, the benefit-cost ratios rose to 2.14. When additional costs of lost production were added, it increased to 2.52 (chapter 9). From a societal perspective, social return on investment analysis reported a social impact of £2.6 to £6.9 for every £1 invested in the yoga programme (chapter 10).
This thesis showed that a multiple method approach to economic evaluation can be effectively applied to public health interventions in workplace settings. This approach provided key stakeholders with a broad range of evidence upon which to base decisions regarding the allocation of scarce resources (chapter 11).