Supported Employment for US Veterans With SCI

A study was conducted to examine the cost-effectiveness of a supported employment intervention for US veterans (Sinnott et al. 2014). This intervention included the services of vocational rehabilitation counselors to the interdisciplinary health care teams. Cost inputs were identified through questionnaires administered to the vocational rehabilitation counselors, participants and from Veterans Affairs databases. The clinical outcome of interest was QALYs extrapolated from a modified SF-36 survey completed at quarterly visits by veterans. Total and incremental costs and effects were estimated using bivariate and multivariate regression models. In the bivariate analysis, the cost for the supported employment cohort was about $5,800 USD less than those not receiving this intervention. There was a QALY gain of 0.01 in the conventional care cohort. Neither the cost nor QALY gain was statistically significant. In the multivariate analysis, the cost was $6,400 USD less and the authors reported a decrease in QALYs. Neither were found to be statistically significant. The authors concluded that the supported employment intervention was not cost-effective when compared to usual care.