Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.
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The investigators acknowledge the excellent support of the VA West Haven Cooperative Studies Program Coordinating Center and excellent technical assistance provided by Judy Burt and Teddy Bishop at the Tuscaloosa VA Medical Center.
Clinical Trial Registration
This study assessed the cost-effectiveness of interventions for individuals who had participated in a randomized controlled trial. clinicaltrials.gov Identifier: NCT01817712.
Standards of Reporting
This study reports results of a cost-effectiveness analysis consistent with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement.
This work was supported by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service Project IIR 15-342. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Conflict of interest
Stefan Kertesz reports receipt of royalty income from UpToDate, Inc. related to a chapter on homeless health care. The authors have no conflict of interests to disclose that pertain to the subject of this manuscript or study. Stefan Kertesz attests to ownership in stock from Thermo Fisher Scientific and Zimmer Biomet. He attests to past ownership of stock in CVS Caremark, sold in 2020.
This study was approved by the Birmingham, Hines, and Tuscaloosa Veterans Health Administration Institutional Review Boards. This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
All participants provided informed consent for the original randomized controlled trial (RCT). The current study was a cost-effectiveness analysis that used data from the original RCT linked to national Veterans Health Administration databases to obtain information on healthcare costs. The original RCT was funded by the Department of Veterans Affair Cooperative Studies Program. Separate funding for the cost-effectiveness analysis was obtained from the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service. As noted above, the current cost-effectiveness study was approved by the Birmingham, Hines, and Tuscaloosa Veterans Health Administration Institutional Review Boards (IRBs). The cost-effectiveness study used only retrospective data and obtained waivers of consent from the IRBs.
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Stroupe, K.T., Jordan, N., Richman, J. et al. Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder. Adm Policy Ment Health 49, 429–439 (2022). https://doi.org/10.1007/s10488-021-01173-z