Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society

Abstract

Background Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program – JUMP) earmarked for individuals with schizophrenia in Norway. Methods The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). Results We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. Conclusion In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. Trial registration ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.

Living beyond the limitation: Rehabilitation, life and productivity of individuals with schizophrenia in South‐West Nigeria

“…This study revealed that individuals with schizophrenia are able to start small businesses, work in a formal setting and even learn new skills that will help them live and sustain a productive life. This is consistent with the finding that individuals with schizophrenia in paid jobs have boosted morale and increased quality of life 30 . Although the participants in this study earn less than a dollar per day, they stated that the amount is sufficient to meet their basic needs.…”

“…This is consistent with the finding that individuals with schizophrenia in paid jobs have boosted morale and increased quality of life. 30 Although the participants in this study earn less than a dollar per day, they stated that the amount is sufficient to meet their basic needs.…”

G-estimation of causal pathways in vocational rehabilitation for adults with psychotic disorders – a secondary analysis of a randomized trial

“…The augmented VR program JUMP has previously documented cost-effectiveness, improved occupational outcomes and improved levels of apathy and neurocognition [14,16,42]. In this study, causal pathways were assessed, by means of g-estimation, to quantify the magnitude and nature of specific effects that were targets in the CBT and CR groups.…”

“…The JUMP Study was a randomized, multisite hybrid VR program for adults with psychotic disorder in Norway [ 12 – 14 ]. Significant improvements in occupational outcomes were found in both groups (VR + CR versus VR + CBT) across an observation period of two years, with a non-significant group difference [ 15 – 17 ]. Also, both neurocognition and symptoms improved, so far best documented with respect to neurocognitive measures [ 12 , 14 ].…”

Psychosocial rehabilitation interventions in the treatment of schizophrenia and bipolar disorder

“…This is a place-support approach. Job placement was first thought could have negative effects in the patient group with a high-stress sensitivity, but studies have later shown that instead of creating a burden for patients, having a job reduced hospitalizations, increased quality of life, and decreased cost with high rates of entering and staying in a job ( 66 – 68 ). Supported employment is recommended by treatment guidelines ( 26 – 28 , 33 , 34 ).…”