Prospective pilot evaluation of the effectiveness and cost-utility of a health first case management service for long-term Incapacity Benefit recipients

In line with the NICE guidance, an NHS-commissioned case management intervention was provided for individuals receiving Incapacity Benefit payments for 3 years in the North East of England. The intervention aimed to improve the health of the participants. A total of 131 participants receiving the intervention were compared over 9 months with a (non-equivalent) comparison group of 229 receiving Incapacity Benefit payments and usual care. Health was measured using EQ-5D, EQ-VAS, SF-8, HADS and the Nordic Musculoskeletal questionnaire. Socio-demographic and health behaviour data were also collected. Fixed-effects linear models with correlated errors were used to compare health changes between groups over time. A preliminary costutility analysis was also conducted. The comparison group measures of health were stable over time. Starting from comparatively poor initial levels, case-management group generic (EQ5D, EQ-VAS) and mental health (HADS-A, HADS-D and SF8-MCS) measures improved within 6 months to similar levels found in the comparison group. Musculoskeletal (Nordic 2) and health behaviours did not improve. Tentative estimates of costutility suggest an intervention cost in the region of 16 70023 500 per QALY. Case management interventions may improve the health of Incapacity Benefit recipients. Further research is required to help confirm these pilot findings.