Cost-Effectiveness of Two Vocational Rehabilitation Programs for Persons With Severe Mental Illness
Abstract
OBJECTIVE: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help patients obtain competitive jobs and provide them with ongoing support, and enhanced vocational rehabilitation (EVR), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. METHODS: A total of 150 unemployed inner-city patients with severe mental disorders who expressed an interest in competitive employment were randomly assigned to IPS or EVR programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. RESULTS: No statistically significant differences were found in the overall costs of IPS and EVR. Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The ICER estimates indicated that participants in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of $283 ($13 an hour). CONCLUSIONS: The analyses suggest that IPS participants engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.
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One RCT found that depending on the outcome measured, SE/IPS may or may not be more effective than other vocational rehabilitation programs.
“One RCT investigated the cost-benefit of SE compared to other vocational rehabilitation programs [68]. Depending on the outcome measured, SE/IPS may or may not be more effective.”
From Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support (2019) · cites this paper as [68]
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- Authors
- Dixon, L., Hoch, J. S., Clark, R., Bebout, R., Drake, R., McHugo, G., & Becker, D.
- Affiliations
- University of Maryland, Baltimore (US)
- Venue
- Psychiatric Services
- Published
- 2002-09
- Volume
- 53
- Issue
- 9
- Pages
- 1118-1124
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2162345757
- Cited by
- 45
- References
- 21
- Citations by year
- 2023: 2 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 3
- FWCI
- 13.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- Ontario Ministry of Health and Long-Term Care
- National Institutes of Health (5k02mh000839-10, 1k20mh001250-01)
- Substance Abuse and Mental Health Services Administration
- Natural Sciences and Engineering Research Council of Canada
- National Institute of Mental Health (MH-00839, MH 51346, K20-MH-01250-01)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD5-SM51346)
- Topics
- Social Sciences › Safety Research › Disability Education and Employment
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- cost-effectiveness, vocational rehabilitation, Individual Placement and Support, severe mental illness, competitive employment, employment effects, wages, mental health costs
- MeSH terms
- Mental Disorders, Cost-Benefit Analysis, Humans, Rehabilitation, Vocational, Employment, Supported, Treatment Outcome
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