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

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 groupor the TVS group. Clinical and vocational outcomes were assessedat baseline and 12-month follow-up. Service utilization data were collectedmonthly. 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, meancost for medical services in the CR + SE group was significantly lower than that in the TVS group after adjusting covariates (B = -$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 beingmore 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.