Cost-effectiveness of supported employment for veterans with spinal cord injuries.
OBJECTIVE
To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs).


METHODS
Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI.


METHODS
SCI centers in the Veterans Health Administration.


METHODS
Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76).


METHODS
A vocational rehabilitation program of SE for veterans with SCI.


METHODS
Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities.


RESULTS
Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care.


CONCLUSIONS
An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI.
VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA. Electronic address: Patricia.sinnott@va.gov.
Patricia L
PL
Sinnott
VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
Vilija
V
Joyce
VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
Pon
P
Su
Health Services Research and Development/Rehabilitation Research and Development Center of Excellence Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, Tampa, FL.
Lisa
L
Ottomanelli
Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA.
Lance L
LL
Goetz
VA Health Economics Resource Center, and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA.
Todd H
TH
Wagner
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D016832:Employment, Supported / Q000191:economics* / Q000379:methods; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006782:Hospitals, Special; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012050:Rehabilitation, Vocational / Q000191:economics* / Q000379:methods; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014195:Travel / Q000191:economics; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
Cost-benefit analysis; Rehabilitation; Spinal cord injuries; Vocational rehabilitation