title: Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial.
abstract: 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.
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yamaguchi
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: S
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: N
authors.initials: N
authors.lastname: Horio
authors.affiliation: Department of Social Welfare, Faculty of Human and Social Sciences,Showa Women's University,Setagaya,Tokyo,Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shimodaira
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: A
authors.initials: A
authors.lastname: Taneda
authors.affiliation: Department of Psychiatry,School of Medicine, Teikyo University,Itabashi, Tokyo,Japan.
authors.forename: E
authors.initials: E
authors.lastname: Ikebuchi
authors.affiliation: School of Social Welfare, Tohoku Fukushi University,Sendai,Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nishio
authors.affiliation: Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan.
authors.forename: J
authors.initials: J
authors.lastname: Ito
mesh_terms: D000328:Adult; D060825:Cognitive Dysfunction / Q000534:rehabilitation*; D000072466:Cognitive Remediation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D016832:Employment, Supported / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012050:Rehabilitation, Vocational / Q000191:economics* / Q000379:methods; D055815:Young Adult
keywords: Cognitive remediation; cost-effectiveness analysis; randomized controlled trials; schizophrenia; supported employment