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

  • S. Yamaguchi (a1), S. Sato (a1), N. Horio (a1), K. Yoshida (a2), M. Shimodaira (a1), A. Taneda (a1), E. Ikebuchi (a3), M. Nishio (a4) and J. Ito (a1)...



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).


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.


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.


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


Corresponding author

*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:


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