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

<jats:sec id="S0033291716002063_sec_a1"><jats:title>Background</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec id="S0033291716002063_sec_a2" sec-type="methods"><jats:title>Method</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S0033291716002063_sec_a3" sec-type="results"><jats:title>Results</jats:title><jats:p>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, <jats:sc>s.d.</jats:sc> = $6372, TVS group: $11 063, <jats:sc>s.d.</jats:sc> = $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 (<jats:italic>Β</jats:italic> = −$3979, 95% confidence interval −$7816 to −$143, <jats:italic>p</jats:italic> = 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.</jats:p></jats:sec><jats:sec id="S0033291716002063_sec_a4" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>CR + SE appears to be a cost-effective option for people with mental illness who have low cognitive functioning when compared with TVS.</jats:p></jats:sec>