Cost-effectiveness analysis of a supported employment intervention for people with mood and anxiety disorders in Denmark – the IPS-MA intervention

Abstract

Objectives

We aimed to investigate the cost-utility and cost-effectiveness of a modified Individual Placement and Support intervention for people with mood and anxiety disorders (IPS-MA).

Methods

Costs were assessed from a societal perspective. Health care costs were derived from registers and combined with data on use of IPS-MA services, municipal social care, and labour market services. EQ-5D was used to compute QALY. Missing data were imputed in a sensitivity analysis. We also computed the cost per gain in hours worked. Incremental cost-effectiveness ratios (ICER) were computed and bootstrapped to obtain confidence intervals for QALY and gain in hours worked.

Results

We found no difference in overall costs between groups. A significant saving was found in use of labour market services in the IPS-MA group. But the IPS-MA group had significantly lower wage earnings compared to the control group. The intervention group had a higher, though statistically in-significant, increase in QALYs than the control group. The ICER did not show statistically significant results, but there was a tendency, that IPS-MA could have a positive effect on health-related quality of life without any additional costs. However, participants in the IPS-MA group had a significantly lower gain in hours worked compared to the control group.

Conclusions

Despite a significant saving in use of labour market services, IPS-MA was not cost-effective. Participants in the IPS-MA group worked significantly fewer hours and earned significantly less than participants in the control group at 1-year follow-up.

Keywords:

• Individual placement and support
• IPS-MA
• cost-effectiveness

Ethical approval

The study was approved by The Regional Ethics Committees of the Capital Region (journal no: H-2-2011-FSP20), reported to the Danish Data Protection Agency (Journal no: 2007-58-0015, local journal no: RHP-2011-20), and registered at http://www.clinicaltrials.gov (identifier: NCT01721824).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Informed consent

All participants provided oral and written informed consent prior to inclusion in the study.

Authors contributions

All authors participated in the planning and design of the study, interpretation of the results, and have read and critically revised the manuscript. MK conducted the analysis and drafting of figures, and tables. LH wrote the manuscript. RTW made a systematic search for studies of cost-effectiveness in the area and wrote part of the introduction. MK wrote the materials and methods section regarding the cost-effectiveness analysis.

Data availability statement

Data from the study is available on request due to privacy/ethical restrictions.

Additional information

Funding

The randomized trial was funded by the Obel Family Foundation, the Tryg Foundation, and the Danish Agency for Labour Market and Recruitment. No current or future sponsors of the trial have had any role in the trial design, collection of data, analysis of data, data interpretation, or in publication of data from the trial.

Notes on contributors

Lone Hellström

Lone Hellströom, MSc (Health), PhD, with expertise in randomized trials, mental illness and vocational rehabilitation.

Marie Kruse

Marie Kruse, MSc (Econ), PhD., with expertise in register based analysis and health economics.

Thomas Nordahl Christensen

Thomas Nordahl Christensen, MSc, PhD, with expertise in randomized trials, mental illness and vocational rehabilitation.

Rasmus Trap Wolf

Rasmus Trap Wolf, MSc, PhD, with expertise in economic evaluation.

Lene Falgaard Eplov

Lene Falgaard Eplov, MD, PhD, Head of the research team Recovery and Inclusion, with expertise in randomized trials, mental illness and vocational rehabilitation.