Table 1.
Summary results for studies with quality scores of 50% and above.
| Study | Country | Study design/Economic evaluation | Outcome | Perspective | Main economic finding | Net intervention cost and funder of SE | Which sectors benefit? a | Time horizon | Quality score |
|---|---|---|---|---|---|---|---|---|---|
| IPS studies | |||||||||
| Christensen et al. [18] | Denmark | RCT/CEA, CUA | QALYs (EQ-5D), Employment |
Societal | 96% probability of being cost-effective at €35,000 WTP | €914, NS | All sectors: €10,457 LGovt (LM): 29% |
1.5 years | 95% |
| Deloitte [19] | UK | Model/CBA | NMB | Health, public purse and service users | Net benefits of at least £7,870 per service user if employment sustained for 3 months | £921, HC | All sectors: £1,436 HC: 26% WF: 16% SOC: 23% OTH: 35% |
1 year | 70% |
| Hellström et al. [20] | Denmark | RCT/CEA, CUA | QALYs (EQ-5D), Employment | Societal | 83–95% probability of being cost-effective at €30,000 WTP. Not cost-effective if cost per hour worked used | €1,183, NS | Overall: No significant difference WF: €4,262 SOC: −€3,376 |
1 year | 78% |
| Heslin et al. [21] | UK | RCT/CEA | Employment | Health care | Higher rates of employment; cost-savings associated with IPS | NS, NS | Overall: No significant difference | 2 years | 56% |
| Hoffmann et al. [22] | Switzerland | RCT/ROI | Employment | Societal | Improved employment; Social ROI: 132% | CHF:14,917, NS | SOC: CHF 29,884 | 5 years | 52% |
| Holmås et al. [23] | Norway | RCT/CBA | NMB | Societal | Higher rates of employment; cost savings associated with IPS | NOK 100,000, WF, HC | Total: NOK 317,000 WF: 67% SOC: 33% |
3.6 years | 65% |
| Howard et al. [24] | UK | RCT/CEA | Employment | Health care | No difference in employment, lower cost associated with IPS | £291, NS | HC: £1,880 | 1 year | 56% |
| Khalifa et al. [25] | UK | RCT/CEA | Employment | Health care | 9% higher rate of employment; No significant change in costs | NS, NS | No significant difference | 1 year | 70% |
| Knapp et al. [17] | Netherlands, UK, Italy, Bulgaria, Switzerland, and Germany | RCT/CBA, CEA | Employment, NMB | Societal | IPS associated with lower health care costs and higher rates of employment | £-4,022, HC | CEA: HC: £5,233 NMB: SOC: £17,005 |
1.5 years | 91% |
| Mavranezouli et al. [26] | UK | Model/CEA, CUA | QALYs (SF-6D) | Health care | 80% probability of being cost-effective at £30,000 WTP | £2,302, HC | HC: £1,700 | 8 years | 92% |
| Mental Health Reform [27] | Ireland | Model/CEA | Employment | Provider | Cost per job was €8,374 | €2,451, NS | WF: €1,614 per job | 2 years | 61% |
| Parlettaa and Waghorn [28] | Australia | Cohort study/CBA | Employment | Provider, public purse | Higher rate of employment; higher net revenue associated with IPS. Lower cost to government | $A 779, Government | Govt total expenditure per 26 week employment outcome: $A 3,855 | 1.5 years | 52% |
| Perkins et al. [29] | UK | Model/ROI | Employment | Societal | ROI = 1.72 assuming 56% improved job rate in IPS group | £1,333, Govt | SOC: £2,319 | 2 years | 56% |
| Rosenheck et al. [30] | USA | RCT/CBA, CUA | QALYs (QLS), NMB | Health care | 94% probability of being cost-effective at $40,000 WTP. 80% probability of positive net monetary benefit if QALY valued at $20,000 | NS, HC | No significant difference | 2 years | 87% |
| Saha et al. [31] | Sweden | RCT/CEA, CUA | QALYs (EQ-5D, MANSA) | Societal | Improved quality of life; cost savings associated with IPS | €-1,299, NS | SOC: €5,948 | 1 year | 74% |
| Sambo [32] | Canada | RCT/CEA, CUA | Employment, QALYs (EQ-5D, QLS) | Health care | Improved employment; nonsignificantly higher quality of life, cost savings associated with IPS | $CAN 321.34, HC | No significant difference | 1 year | 91% |
| Shi [33] | Canada | RCT/CEA | Employment | Societal | Higher rate of employment and higher wages; cost savings associated with IPS | $CAN 4,778, HC | Three overlapping sets of benefits HC: $CAN 5,752 Govt: $CAN 5,739 SOC: $5,442 |
1.5 years | 87% |
| Stant et al. [34] and van Busschbach et al. [35] | Netherlands | RCT/CEA, CUA | Employment, QALYs (MANSA) | Societal | 80% probability of being cost-effective at €2,000 WTP per additional 1% employed. No difference in quality of life | €529, NS | Overall: No significant difference | 2.5 years | 83% |
| Stroupe et al. [36] | USA | RCT/CEA, ROI | Employment | Societal | 95% probability of being cost-effective at $81 WTP per additional hour worked. ROI 0.329 for IPS versus 0.296 for transitional work | $3,839, HC | Overall: No significant difference | 1.5 years | 87% |
| Szplit [37] | UK | Observational study/CBA, ROI | Employment, NMB | Employment | ROI = 5.01; net present value: £449,063 | £1,729, HC | Total: £11,709 WF: 51% HC: 15% Employers: 1% SOC: 33% |
5 years | 57% |
| van Stolk et al. [38] | UK | Model/CBA | NMB | Public purse | Benefit–cost ratio of £1.41 for every £1 spent to achieve employment outcome | £75,000 (per employment specialist), Govt | Total £118,913 HC: 9% Govt: 91% |
1 year | 70% |
| Washington State Institute for Public Policy [39] | USA | Model/CBA | NMB | Societal | Benefit–cost ratio of $7.70. 80% probability of positive NMB | $849, NS | All sectors $7,014 Govt: 30% HC: 0.002% SOC: 69.9% |
50 years | 74% |
| Whitworth [40] | UK | Model/CBA | NMB | Health care | Benefit–cost ratio of 0.32–7.47 depending on scenario | £1,200–£3,500, Govt | No cost breakdown provided | 10 years | 70% |
| IPS plus studies | |||||||||
| Christensen et al. [18] | Denmark | RCT/CEA, CUA | QALYs (EQ-5D) | Societal | 95% probability of being cost-effective at €35,000 WTP | €2,543, NS | All sectors: €9,831 LGovt: 30% HC: 51% |
1.5 years | 95% |
| Reme et al. [41] | Norway | RCT/CBA, CUA | QALYs (EQ-5D), NMB | Societal | Improved quality of life. Positive NMB of NOK 7,694 per person per year for long-term welfare dependent | NOK: 28,043, WF | All sectors: NOK 35,737 WF: 11% HC: 10% SOC: 79% |
1 year | 87% |
| Schneider et al. [42] | UK | RCT/CEA | Employment | Health care | Only if WTP per wage hour reaches £100 is there a 50% probability of being cost-effective | £136, HC | HC: £86.8, 100% | 1 year | 74% |
| Yamaguchi et al. [43] | Japan | RCT/CEA | Cognition, Employment | Health and social care | Higher rate of employment. 78% probability of being cost-effective at $0 WTP | $1,287, NS | Overall: No significant difference HC: $2,682 100% |
1 year | 87% |
| Other supported employment | |||||||||
| Cimera [44] | USA | Cohort Study/CEA | Employment | Public purse | Higher costs per hour worked in supported employment than SW | $-252, Govt | NS | NS | 61% |
| Cimera et al. [45] | USA | Matched cohort study/CEA | Employment | Public purse | Better weekly earnings, lower service costs for non-SW than the SW group | $-3,624, Govt | SOC: $62 per week | 5 years | 53% |
| Cimera [46] | USA | Matched cohort study/CEA | Employment | Public purse | Lower cost per dollar earned for the SE group than SW | $-3,352, Govt | SOC: $19 per week | 8.5 years | 56% |
| Cimera [47] | USA | Cohort study/CBA | NMB | Public purse | Benefit–cost ratios ranged from 0.63 to 2.77 | $636 per month, Govt | WF: $770 per month | 1 year | 56% |
| Cimera [48] | USA | Match cohort study/CBA | NMB | Public purse | Benefit–cost ratios of 0.46, 0.56, 0.73 for individuals in the no transition, school transition and community transition groups respectively | $941–$1,345 per month, State Govt | WF: $54–$189 State Govt: $497 |
NS | 56% |
| Cimera [49] | USA | Cohort study/CBA | NMB | Public purse | Benefit to cost ratio of 1.46 from a taxpayer perspective for all service users | $544, Govt | WF: $796 | 1 year | 65% |
| Dattilo [50] | USA | Cohort study/CBA | NMB | Public purse | There were net benefits of $9,165 and $2,093 in the on-site and off-site groups | On-site $1,732, Off-site $284, State Govt (Rehabilitation) | On-site only HC: $10,897 | 0.5 year | 56% |
| Evensen et al. [51] | Norway | Matched cohort/CUA | QALYs (EQ-5D) | Health and social care | 85% probability of being cost-effective at €62,000 WTP | €9,131, WF | HC: €10,621 | 4 years | 78% |
| Fogelgren et al. [3] | Sweden | Model/CBA | NMB | Societal | Gains from supported employment exceed costs after 12 years | €764–5900, Employment Services | SOC: €50 per month of employment | 12 years | 61% |
| Hagen 2018 [52] | Switzerland | Model/CBA | NMB | Public purse | Benefit cost ratio of 1.9–6.5 under different scenarios | CHF 8,819, Disability Insurance | WF: Between CHF 16,819 and €57,119 | 20 years | 70% |
| Indecon [53] | Ireland | Cohort study/CEA | Employment | Public purse | Cost per job sustained €13,582 | Monthly expenditure per client: €222–228, WF | NS | 4 years | 61% |
| Schneider et al. [54] | UK | Cohort study/CCA | Employment | Societal | The cohort who started work reduced their consumption of mental health services by an average of £23.93 | 3 month costs ranged from £31 to $238, HC | Per week: SOC: if working £70.53, not working £11.09 WF: if working £25, not working £12 |
1 year | 65% |
| Sultan-Taib et al. [55] | Canada | Cohort study/CUA | QALYs (EQ-5D) | Health care | No impact on quality of life. Health care costs lower in comparison social firm group | NS, HC | HC: $CAN −$1,924 | 1 year | 70% |
| Tholen et al. [56] | Sweden | Registry data /Model/CBA, ROI | NMB | Public purse | Benefit cost ratio of 3.09–4.99 under different scenarios | SEK 20 Million (69 young people), Local government | Municipality: SEK 21,128 Million | 7.5 years | 70% |
Abbreviations: CCA, cost consequences analysis; CEA, cost-effectiveness analysis; Govt, government; HC, health care sector; LGovt, local government; MANSA, Manchester short assessment of quality of life; NMB, net monetary benefits; NS, not stated; OTH, other; QALYs, quality-adjusted life years; QLS, quality of life scale; RCT, randomised controlled trial; SOC, society; SW, sheltered workshop; WF, welfare sector; WTP, willingness to pay.
a
Only significant differences for sectors reported.