Article Details

Research Database: Article Details

Citation:  Sinnott, P.L., Joyce, V., Su, P., Ottomanelli, L., Goetz, L., Wagner, T.H. (2014). Cost-effectiveness of supported employment for veterans with spinal cord injuries. Archives of Physical Medicine and Rehabilitation, 95 (7), 1254-61.
Title:  Cost-effectiveness of supported employment for veterans with spinal cord injuries
Authors:  Sinnott, P.L., Joyce, V., Su, P., Ottomanelli, L., Goetz, L., Wagner, T.H.
Year:  2014
Journal/Publication:  Archives of Physical Medicine and Rehabilitation
Publisher:  American Congress of Rehabilitation Medicine
DOI:  https://doi.org/10.1016/j.apmr.2014.01.010
Full text:  http://proxy.library.vcu.edu/login?url=http://www.archives-pmr.org/...   
Peer-reviewed?  Yes
NIDILRR-funded?  No
Research design:  Randomized controlled trial

Structured abstract:

Background:  The Veterans Health Administration (VA) cares for roughly 26,000 veterans with spinal cord injury (SCI). For those veterans who wish to return to work after SCI a supported employment program (SE) was developed and applied to this specific population group. SE focuses on the abilities of the patient and the patient receives very integrated support from the clinical treatment team. In a randomized trial SE was shown to be very effective in helping veterans with SCI achieve competitive employment as compared to receiving care as usual.
Purpose:  This study aims to determine whether SE for veterans is cost effective as compared to receiving care as usual. Follow up was done after one year to determine cost effectiveness of the treatment.
Setting:  SCI centers within the VA system and employment sites for study participants.
Study sample:  One hundred fifty seven (N=157) veterans aged 18 to 65 years not competitively employed or employed at wages less than Social Security‚Äôs definition of competitive employment. Participants came from five different VA medical centers.
Intervention:  Participants were randomly assigned to either receive SE (N=81) or to receive care as usual (N=76). A biased coin design was used to force balance in treatment groups. Follow up was done after one year to determine average costs of SE compared to care as usual.
Control or comparison condition:  A control group (N=76) received care as usual and not the SE intervention.
Data collection and analysis:  Costs of both the intervention and the control were collected based on how much it would cost (with benefits) for employees to administer SE and treatment as usual. Cost effectiveness was estimated based on guidelines from the U.S. Public Health Service on Cost-Effectiveness in Health and Medicine. Cost effectiveness was then calculated using the incremental cost effectiveness ratio.
Findings:  Measures indicating the cost effectiveness of treatments such as total cost, health care utilization by patients, and average quality of life were not significantly different between groups at the one year follow up. The findings suggest that the SE program is not cost effective when compared with care as usual.
Conclusions:  While a SE program for veterans has the benefit of helping achieve competitive employment it does not appear to be cost effective after one year. This study is limited in that the single follow up was done after only one year. Further research that continues to follow up with patients after one year of SE is necessary to determine the long term cost effectiveness.

Disabilities served:  Spinal cord injury (SCI)
Populations served:  Veterans
Interventions:  Supported employment