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Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial

Published online by Cambridge University Press:  22 September 2016

S. Yamaguchi ,
S. Sato ,
N. Horio ,
K. Yoshida ,
M. Shimodaira ,
A. Taneda ,
E. Ikebuchi ,
M. Nishio  and
J. Ito
S. Yamaguchi*
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
S. Sato
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
N. Horio
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
K. Yoshida
Affiliation:
Department of Social Welfare, Faculty of Human and Social Sciences, Showa Women's University, Setagaya, Tokyo, Japan
M. Shimodaira
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
A. Taneda
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
E. Ikebuchi
Affiliation:
Department of Psychiatry, School of Medicine, Teikyo University, Itabashi, Tokyo, Japan
M. Nishio
Affiliation:
School of Social Welfare, Tohoku Fukushi University, Sendai, Japan
J. Ito
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
*
*Address for correspondence: S. Yamaguchi, Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan. (Email: [email protected])
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Abstract

Background

Little is known about the economic benefits of cognitive remediation and supported employment (CR + SE). The present study aimed to investigate the cost-effectiveness of CR + SE compared with traditional vocational services (TVS).

Method

Individuals with mental illness and low cognitive function were recruited at six sites in Japan. A total of 111 participants were randomly allocated to the CR + SE group or the TVS group. Clinical and vocational outcomes were assessed at baseline and 12-month follow-up. Service utilization data were collected monthly. The data on outcomes and costs were combined to examine cost-effectiveness.

Results

The data were obtained from a total of 92 participants. The CR + SE group resulted in better vocational and clinical outcomes (employment rate, 62.2%; work tenures, 78.6 days; cognitive improvement, 0.5) than the TVS group (19.1%, 24.9 days and 0.2). There was no significant difference in mean total costs between the groups (CR + SE group: $9823, s.d. = $6372, TVS group: $11 063, s.d. = $11 263) with and without adjustment for covariates. However, mean cost for medical services in the CR + SE group was significantly lower than that in the TVS group after adjusting covariates (Β = −$3979, 95% confidence interval −$7816 to −$143, p = 0.042). Cost-effectiveness acceptability curves for vocational outcomes illustrated the high probabilities (approximately 70%) of the CR + SE group being more cost-effective than TVS when society is not willing to pay additional costs.

Conclusions

CR + SE appears to be a cost-effective option for people with mental illness who have low cognitive functioning when compared with TVS.

Keywords

Cognitive remediationcost-effectiveness analysisrandomized controlled trialsschizophreniasupported employment
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 53 - 65
Copyright
Copyright © Cambridge University Press 2016 

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