Copenhagen Research Center for Mental Health - CORE, Copenhagen, Denmark.
Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
Eur Psychiatry. 2020 Dec 21;64(1):e3. doi: 10.1192/j.eurpsy.2020.111.
Administrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly.
In a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant's responses to the EQ-5D questionnaire, and for hours in employment.
Both IPS and IPSE were less costly, and more effective than SAU. Overall, there was a statistically significant cost difference of €9,543 when comparing IPS with SAU and €7,288 when comparing IPSE with SAU. ICER's did generally not render statistically significant results. However, there was a tendency toward the IPS and IPSE interventions being dominant, that is, cheaper with greater effect in health-related quality of life and hours in employment or education compared to usual care.
Individual placement support with and without a supplement of cognitive remediation tends to be cost saving and more effective compared to SAU.
行政人员和政策制定者越来越有兴趣将个体安置和支持（IPS）作为帮助严重精神疾病（SMI）患者获得就业或教育的一种方式。因此，调查其成本效益以确保资源得到合理利用非常重要。
在一项随机临床试验中，将 720 名被诊断为 SMI 的患者分为三组；（a）IPS，（b）IPS 辅以认知矫正和社交技能训练（IPSE），和（c）常规服务（SAU）。从全国范围内的登记处提取医疗保健费用、市社会护理费用和劳动力市场服务费用，并结合 IPS 服务使用数据。使用 EQ-5D 问卷对参与者的反应进行质量调整生命年（QALY）和就业时间的成本效用和成本效果分析。对于 QALY 和就业时间，计算了增量成本效果比（ICER）。
IPS 和 IPSE 的成本均低于 SAU，且效果更佳。总体而言，IPS 与 SAU 相比，成本差异具有统计学意义，为 9543 欧元；而 IPSE 与 SAU 相比，成本差异具有统计学意义，为 7288 欧元。ICER 结果通常没有统计学意义。然而，IPS 和 IPSE 干预措施具有优势的趋势，即与常规护理相比，在健康相关的生活质量和就业或教育时间方面，成本更低，效果更好。
个体安置支持加上或不加上认知矫正，与常规服务相比，具有节省成本和更有效的趋势。
