Cost-effectiveness of two vocational rehabilitation programs for XXXX with severe mental illness.

@entity1 @entity10679 @entity14782 @entity146
OBJECTIVE: This study sought to determine differences in the cost-effectiveness of two vocational programs: individual placement and support (IPS), in which employment specialists within a mental health center help @entity1 obtain competitive jobs and provide them with ongoing support, and @entity14782 ( @entity14782 ), in which stepwise services that involve prevocational experiences are delivered by rehabilitation agencies. METHODS: A total of 150 unemployed inner-city @entity1 with severe @entity146 who expressed an interest in competitive employment were randomly assigned to IPS or @entity14782 programs and were followed for 18 months. Wages from all forms of employment and the number of weeks and hours of competitive employment were tracked monthly. Estimates were made of direct mental health costs and vocational costs. Incremental cost-effectiveness ratios (ICERs) were calculated for competitive employment outcomes and total wages. RESULTS: No statistically significant differences were found in the overall costs of IPS and @entity14782 . Participation in the IPS program was associated with significantly more hours and weeks of competitive employment. However, the average combined earnings-earnings from competitive and noncompetitive employment-were virtually the same both programs. The @entity10679 estimates indicated that @entity1 in the IPS program worked in competitive employment settings for an additional week over the 18-month period at a cost of  283 ( 13 an hour). CONCLUSIONS: The analyses suggest that IPS @entity1 engaged in competitive employment at a higher cost. When combined earnings were used as the outcome, data from the statistical analyses were insufficient to enable any firm conclusions to be drawn. The findings illustrate the importance of choice of outcomes in evaluations of employment programs.
