Yamaguchi S, Sato S, Horio N, Yoshida K, Shimodaira M, Taneda A, Ikebuchi E, Nishio M, Ito J
Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
Department of Social Welfare, Faculty of Human and Social Sciences,Showa Women's University,Setagaya,Tokyo,Japan.
Psychol Med. 2017 Jan;47(1):53-65. doi: 10.1017/S0033291716002063. Epub 2016 Sep 22.
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.
关于认知康复与支持性就业（CR + SE）的经济效益知之甚少。本研究旨在调查CR + SE与传统职业服务（TVS）相比的成本效益。
在日本的六个地点招募了患有精神疾病且认知功能低下的个体。总共111名参与者被随机分配到CR + SE组或TVS组。在基线和12个月随访时评估临床和职业结局。每月收集服务利用数据。将结局和成本数据相结合以检查成本效益。
数据来自总共92名参与者。CR + SE组在职业和临床结局方面（就业率62.2%；工作任期78.6天；认知改善0.5）比TVS组（19.1%、24.9天和0.2）更好。在调整协变量前后，两组之间的平均总成本没有显著差异（CR + SE组：9823美元，标准差 = 6372美元，TVS组：11063美元，标准差 = 11263美元）。然而，在调整协变量后，CR + SE组的医疗服务平均成本显著低于TVS组（Β = -3979美元，95%置信区间 -7816美元至 -143美元，p = 0.042）。职业结局的成本效益可接受性曲线表明，当社会不愿意支付额外成本时，CR + SE组比TVS组更具成本效益的概率很高（约70%）。
与TVS相比，CR + SE对于认知功能低下的精神疾病患者似乎是一种具有成本效益的选择。
