Cost effectiveness and budget impact of the Boston University approach to psychiatric rehabilitation for increasing the social participation of individuals with severe mental illnesses

Sarita A. Sanches*, Talitha L. Feenstra, Wilma E. Swildens, Jooske T. Van Busschbach, Jaap Van Weeghel, Thea D. I. Van Asselt

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background:
The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation.

Method:
In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants.

Results:
Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions.

Conclusions:
This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
Original languageEnglish
Article number880482
JournalFrontiers in Psychiatry
Volume13
DOIs
Publication statusPublished - 2022

Keywords

  • Boston university approach to psychiatric rehabilitation
  • Severe mental illness
  • COST-EFFECTIVENESS
  • BUDGET IMPACT
  • Quality of Life
  • QALY
  • Social participation

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