Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD

Objective: Among veterans with posttraumatic stress dis-order (PTSD), supported employment that utilizes the indi-vidual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs.Methods: A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Compari-sons were also made to an 18-month postintervention period.Results: The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity ser-vices. Annual per-person costs of health services were ap-proximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher uti-lization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to non-significant differences. The mean annual per-person voca-tional service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period.Conclusions: In keeping with IPS's intensive case manage-ment approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should ex-amine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.Psychiatric Services 2022; 73:1109-1116; doi: 10.1176/appi.ps.202100197

Automated summary

Among veterans with PTSD, supported employment using the IPS model has shown better employment and functional outcomes compared to usual vocational rehabilitation services. This study compared the health services use and associated costs between IPS and usual care (TW program) among unemployed veterans. The findings suggest that IPS participants had higher costs primarily due to increased utilization and costs of vocational services during the intervention period. However, these differences declined in the postintervention period.