title: Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol.
abstract: BACKGROUND
  People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT's) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial.
  
  
  METHODS
  In a multisite RCT, 225 adults (18-64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios.
  
  
  CONCLUSIONS
  The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make decisions about further implementation of the method. Also, assessing budgetary impact will facilitate policymaking. The large sample size, geographic coverage and heterogeneity of the study group will ensure reliable generalisation of the study results.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN88987322. Registered 13 May 2014.
authors.affiliation: Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512, PG, Utrecht, The Netherlands. s.sanches@altrecht.nl.|Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000, LE, Tilburg, The Netherlands. s.sanches@altrecht.nl.
authors.forename: Sarita A
authors.initials: SA
authors.lastname: Sanches
authors.affiliation: Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512, PG, Utrecht, The Netherlands. w.swildens@altrecht.nl.
authors.forename: Wilma E
authors.initials: WE
authors.lastname: Swildens
authors.affiliation: University Center for Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands. j.t.van.busschbach@umcg.nl.|Department of Movement and Education, Windesheim University of Applied Sciences, Postbus 10090, 8000, GB, Zwolle, The Netherlands. j.t.van.busschbach@umcg.nl.
authors.forename: Jooske T
authors.initials: JT
authors.lastname: van Busschbach
authors.affiliation: Zovon, Walhofstraat 28, 7522, BL, Enschede, The Netherlands. a.d.stant@zovon.nl.|Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands. a.d.stant@zovon.nl.
authors.forename: A Dennis
authors.initials: AD
authors.lastname: Stant
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands. t.l.feenstra@umcg.nl.
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000, LE, Tilburg, The Netherlands. J.vanWeeghel@tilburguniversity.edu.|Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands. J.vanWeeghel@tilburguniversity.edu.|Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900, AH, Castricum, The Netherlands. J.vanWeeghel@tilburguniversity.edu.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D016832:Employment, Supported / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000534:rehabilitation*; D008875:Middle Aged; D009426:Netherlands; D010865:Pilot Projects; D000067250:Psychiatric Rehabilitation / Q000191:economics / Q000379:methods*; D018401:Sample Size; D020377:Self Efficacy; D016896:Treatment Outcome; D055815:Young Adult