Cost-Effectiveness of Supported Employment for Veterans With Spinal Cord Injuries

Objective: To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs). Design: Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI. Setting: SCI centers in the Veterans Health Administration. Participants: Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76). Intervention: A vocational rehabilitation program of SE for veterans with SCI. Main Outcome Measures: Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities. Results: Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care. Conclusions: An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI. (C) 2014 by the American Congress of Rehabilitation Medicine