Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-26T09:26:31.859Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  22 September 2016

S. Yamaguchi ,
S. Sato ,
N. Horio ,
K. Yoshida ,
M. Shimodaira ,
A. Taneda ,
E. Ikebuchi ,
M. Nishio  and
J. Ito
S. Yamaguchi*
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
S. Sato
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
N. Horio
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
K. Yoshida
Affiliation:
Department of Social Welfare, Faculty of Human and Social Sciences, Showa Women's University, Setagaya, Tokyo, Japan
M. Shimodaira
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
A. Taneda
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
E. Ikebuchi
Affiliation:
Department of Psychiatry, School of Medicine, Teikyo University, Itabashi, Tokyo, Japan
M. Nishio
Affiliation:
School of Social Welfare, Tohoku Fukushi University, Sendai, Japan
J. Ito
Affiliation:
Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
*
*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: sosei.yama@ncnp.go.jp)
Get access Rights & Permissions [Opens in a new window]

Abstract

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 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.

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, 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.

Conclusions

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

Keywords

Cognitive remediationcost-effectiveness analysisrandomized controlled trialsschizophreniasupported employment
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 53 - 65
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Becker, DR, Drake, RE (2003). A Working Life for People with Severe Mental Illness. Oxford University Press: New York.Google Scholar
Bell, MD, Choi, KH, Dyer, C, Wexler, BE (2014). Benefits of cognitive remediation and supported employment for schizophrenia patients with poor community functioning. Psychiatric Services 65, 469–475.CrossRefGoogle ScholarPubMed
Bellack, AS, Green, MF, Cook, JA, Fenton, W, Harvey, PD, Heaton, RK, Laughren, T, Leon, AC, Mayo, DJ, Patrick, DL, Patterson, TL, Rose, A, Stover, E, Wykes, T (2007). Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop. Schizophrenia Bulletin 33, 805–822.CrossRefGoogle Scholar
Bond, GR, Drake, RE, Becker, DR (2012). Generalizability of the individual placement and support (IPS) model of supported employment outside the US. World Psychiatry 11, 32–39.CrossRefGoogle ScholarPubMed
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study. British Journal of Psychiatry 195, 475–482.Google Scholar
Chan, JYC, Hirai, HW, Tsoi, KKF (2015). Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials. Journal of Psychiatric Research 68, 293–300.CrossRefGoogle ScholarPubMed
Clark, RE, Xie, H, Becker, DR, Drake, RE (1998). Benefits and costs of supported employment from three perspectives. Journal of Behavioral Health Services and Research 25, 22–35.Google Scholar
Dixon, L, Hoch, JS, Clark, R, Bebout, R, Drake, R, Mchugo, G, Becker, D (2002). Cost-effectiveness of two vocational rehabilitation programs for persons with severe mental illness. Psychiatric Services 53, 1118–1124.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Heslin, M, Howard, L, Leese, M, McCrone, P, Rice, C, Jarrett, M, Spokes, T, Huxley, P, Thornicroft, G (2011). Randomized controlled trial of supported employment in England: 2 year follow-up of the Supported Work and Needs (SWAN) study. World Psychiatry 10, 132–137.Google Scholar
Hoffmann, H, Jackel, D, Glauser, S, Mueser, KT, Kupper, Z (2014). Long-term effectiveness of supported employment: 5-year follow-up of a randomized controlled trial. American Journal of Psychiatry 171, 1183–1190.Google Scholar
Kaneda, Y, Sumiyoshi, T, Keefe, R, Ishimoto, Y, Numata, S, Ohmori, T (2007). Brief Assessment of Cognition in Schizophrenia: validation of the Japanese version. Psychiatry and Clinical Neurosciences 61, 602–609.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keefe, RSE, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP, Coughenour, L (2004). The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research 68, 283–297.CrossRefGoogle ScholarPubMed
Keefe, RSE, Vinogradov, S, Medalia, A, Buckley, PF, Caroff, SN, D'Souza, DC, Harvey, PD, Graham, KA, Hamer, RM, Marder, SM, Miller, DD, Olson, SJ, Patel, JK, Velligan, D, Walker, TM, Haim, AJ, Stroup, TS (2012). Feasibility and pilot efficacy results from the multisite Cognitive Remediation in the Schizophrenia Trials Network (CRSTN) randomized controlled trial. Journal of Clinical Psychiatry 73, 1016–1022.Google Scholar
Kinoshita, Y, Furukawa, TA, Kinoshita, K, Honyashiki, M, Omori, IM, Marshall, M, Bond G, R, Huxley, P, Amano, N, Kingdon, D (2013). Supported employment for adults with severe mental illness. Cochrane Database of Systematic Reviews 9, CD008297.Google Scholar
Knapp, M, Patel, A, Curran, C, Latimer, E, Catty, J, Becker, T, Drake, RE, Fioritti, A, Kilian, R, Lauber, C, Rossler, W, Tomov, T, Van Busschbach, J, Comas-Herrera, A, White, S, Wiersma, D, Burns, T (2013). Supported employment: cost-effectiveness across six European sites. World Psychiatry 12, 60–68.Google Scholar
Löthgren, M, Zethraeus, N (2000). Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Economics 9, 623–630.Google Scholar
Marker, KR (2014). COGPACK: The Cognitive Training Package Manual, Version 8.8. Marker Software: Ladenburg.Google Scholar
McCrone, P, Craig, TK, Power, P, Garety, PA (2010). Cost-effectiveness of an early intervention service for people with psychosis. British Journal of Psychiatry 196, 377–382.CrossRefGoogle ScholarPubMed
McGurk, SR, Mueser, KT (2004). Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model. Schizophrenia Research 70, 147–173.CrossRefGoogle ScholarPubMed
McGurk, SR, Mueser, KT, Pascaris, A (2005). Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophrenia Bulletin 31, 898–909.Google Scholar
McGurk, SR, Mueser, KT, Xie, H, Feldman, K, Shaya, Y, Klein, L, Wolfe, R (2016). Cognitive remediation for vocational rehabilitation nonresponders. Schizophrenia Research 175, 48–56.Google Scholar
McGurk, SR, Mueser, KT, Xie, H, Welsh, J, Kaiser, S, Drake, RE, Becker, DR, Bailey, E, Fraser, G, Wolfe, R, McHugo, GJ (2015). Cognitive enhancement treatment for people with mental illness who do not respond to supported employment: a randomized controlled trial. American Journal of Psychiatry 172, 852–861.Google Scholar
Medalia, A, Richardson, R (2005). What predicts a good response to cognitive remediation interventions? Schizophrenia Bulletin 31, 942–953.CrossRefGoogle ScholarPubMed
Ministry of Health, Labour and Welfare (2012 a). 2012 Care Payment Unit Costs: Service Cord Table. Ministry of Health, Labour and Welfare: Tokyo, Japan (http://www.mhlw.go.jp/bunya/shougaihoken/jiritsushien/dl/h2404_05-1.pdf). [In Japanese]Google Scholar
Ministry of Health, Labour and Welfare (2012 b). Medical Fee: Revision 2012. Ministry of Health, Labour and Welfare: Tokyo, Japan (http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryouhoken/iryouhoken15/index.html?PHPSESSID=914656edj9b1bbve0obo2l82i3). [In Japanese]Google Scholar
Mirandola, M, Bisoffi, G, Bonizzato, P, Amaddeo, F (1999). Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register. Social Psychiatry and Psychiatric Epidemiology 34, 541–547.Google Scholar
Mogami, T (2007). Cognitive remediation for schizophrenia. Yonago Acta Medica 50, 69–80.Google Scholar
National Personnel Authority (2013). Summary of Salaries for Civil Servants. National Personnel Authority: Tokyo, Japan (http://www.jinji.go.jp/kyuuyo/kou/25gaiyou.pdf). [In Japanese]Google Scholar
Nixon, RM, Wonderling, D, Grieve, RD (2010). Non-parametric methods for cost-effectiveness analysis: the central limit theorem and the bootstrap compared. Health Economics 19, 316–333.Google Scholar
Ogawa, H, Nishio, M, Tsuda, S, Ishii, M, Koda, M, Hisanaga, F (2008). Employment services in Assertive Community Treatment Japan. In Health Labour Sciences Research Grant: Study on Development in Assertive Community Treatment in People with Severe Mental Illness (ed. Ito, J.), pp. 37–44. National Center of Neurology and Psychiatry: Kodaira, Japan. [In Japanese]Google Scholar
Oshima, I, Sono, T, Bond, GR, Nishio, M, Ito, J (2014). A randomized controlled trial of individual placement and support in Japan. Psychiatric Rehabilitation Journal 37, 137–143.Google Scholar
Patel, A, Knapp, M, Romeo, R, Reeder, C, Matthiasson, P, Everitt, B, Wykes, T (2010). Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophrenia Research 120, 217–224.Google Scholar
Reeder, C, Harris, V, Pickles, A, Patel, A, Cella, M, Wykes, T (2014). Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy? Schizophrenia Bulletin 40, 1472–1481.Google Scholar
Sato, S, Iwata, K, Furukawa, S, Matsuda, Y, Hatsuse, N, Ikebuchi, E (2013). The effects of the combination of cognitive training and supported employment on improving clinical and working outcomes for people with schizophrenia in Japan. Clinical Practice and Epidemiology in Mental Health 10, 18–27.Google Scholar
Thornicroft, G, Slade, M (2014). New trends in assessing the outcomes of mental health interventions. World Psychiatry 13, 118–124.CrossRefGoogle ScholarPubMed
Tsang, HW, Leung, AY, Chung, RC, Bell, M, Cheung, WM (2010). Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Australian and New Zealand Journal of Psychiatry 44, 495–504.Google ScholarPubMed
Yamaguchi, S, Shimodaira, M, Yoshida, K, Sato, S, Takahara, Y, Maeda, K, Ichikawa, K, Izumida, N, Ito, J (2012). An instrument for economic evaluation of mental health services: development of the Client Service Receipt Inventory-Japanese version. Seishin Igaku 54, 1225–1236. [In Japanese]Google Scholar
Supplementary material: File

Yamaguchi supplementary material

Tables S1-S5

Download Yamaguchi supplementary material(File)
File 239.1 KB