PA

S versus voca-
versus voca-
dditional cost
67 يسفنلا بطلل ةيلماعلا ةلجلما
Table 4 Incremental cost-effectiveness ratios for IPS versus vocational
services (based on total 18-month costs)
تامدخ عم ةنراقلماب IPS per لا additional ةفلكت ةيلعافل 1% ةيفاصإا Additional بصن :4 cost لودج
)اًرهص of people 18 فيلاكت working عوممج ىلع per موقت( additional فيظوتلا
Cost perspective
Additional cost
at least 1 day
day worked
Overall—available cases IPS dominates IPS dominates
ً
er additional
ditional cost
day worked
r additional
ay ominates worked
Overall—imputed موي لكل ةيفاصإا ةفلكت costs
London—imputed فياصإا لمع costs
%1 لكل ةيفاصإا ةفلكت
IPS dominates
اولغتصا نيذلا نم ةيفاصإا
IPS dominates لقألا ىلع دحاو موي
IPS dominates
IPS dominates
minates ominates
Ulm—imputed costs IPS dominates IPS dominates فيلاكتلا روظنم
minates ominates
Rimini—imputed costs IPS dominates ةفصب IPS dominates ةحاتلما تلالحا
IPS لا ةنميه IPS لا ةنميه
ةلماص
minates ominates
Zurich—imputed costs IPS dominates IPS dominates
ةفصب ةلخدُلما فيلاكتلا
IPS لا ةنميه IPS لا ةنميه
minates ominates
Groningen—imputed costs £233 / 7.7%5£30 £233 / 24.2 days5£10 ةلماص
)£( عفدلا في ةبغرلا
ةصالخا ةلخدُلما فيلاكتلا
minates ominates Figure 2 Probability that Individual Placement and Support is cost- Sofia—imputed IPS لا costs ةنميه IPS dominates IPS لا ةنميه IPS dominates
ندنلب
minates / 24.2 days5£10 Figure effective 2 Probability compared that withIndividual vocationalPlacement services for and a range Support of is values cost- of
IPS – Individual Placement and Support
ةصالخا ةلخدُلما فيلاكتلا
willingness to pay for an additional day of work
IPS لا ةنميه IPS لا ةنميه
ominates ثيح effective نم ةلاعف compared يدرفلا with فيظوتلاو vocational معدلا services تامدخ forنأا a range ةيلامتحأا of values :2 لكصلا of
24.2 days5£10
لموأاب
willingness to pay for an additional day of work
ةصالخا ةلخدُلما فيلاكتلا
minates ميق نم ةعوممج سخي اميف فيظوتلا تامدخ عم ةنراقلماب ةفلكتلا IPS لا ةنميه IPS لا ةنميه
likely to drop out of the service (45%) ينيمرب
ةصالخا
and
ةلخدُلما
to be
فيلاكتلا
read-
فياصإا دحاو لمع مويل عفدلا في ةبغرلا mitted IPS to hospital لا ةنميه (31%) than IPS لا people ةنميه in the IPS arm
خرويزب
of
to be read- IPS Total لل لقأا costs ىلوألا over رهصأا theةتصلا firstللاخ 6 months في فيلاكتلا wereعوممج lower ناك for the دقف IPS the/ينيلترصإا trial ةينج (13% 233and
20%, respectively). The trial also
/ينيلترصإا ةينج 233 ةصالخا ةلخدُلما فيلاكتلا
toIPS be arm read-of
ةنصلا Total group للاخ costs byفي more over تافلاتخلا the than first نكت £2,700, 6لم months نكل but ينيلترصإا differences wereةينج lower 2,700 over for the نم theثركأاب IPS two found ةينج 10=ا thatًموي context 24.2 was important, with local unemploy-
ينيلترصإا ةينج 30 =%7.7
نجنينورجب
IPS e trial armalso of group subsequent by more 6-month than £2,700, periodsbut were differences not significant. over .ةيربك theةقحلالا two ment ratesينيلترصإا explaining a substantial proportion of the
l unemploy- trial also subsequent The cost 6-month of the IPS periods intervention were notitself significant. varied threefold observed IPS variation لا ةنميه in IPS effectiveness.
IPS لا ةنميه ايفوصب ةصالخا ةلخدُلما فيلاكتلا
عقاولما برع فاعصأا ةثلاث اهتاذ IPS لا تلاخدت فيلاكت تفلتخا دقل
rtionunemploy- of the across The cost sites of(being the IPShighest intervention in Sofia itself andvaried lowest threefold in Ulm),
ion of the فيلاكت across فيظوتلاو معدلا ةمدخ :IPS لا
whileتفلتخا sites the costs امنيب (being ,)لموأا ofhighest comparison في اهتاجرد in Sofia ىندأاو interventions and ايفوص lowest في اهتورذ varied in Ulm), تغلبف( more
ىندأاو while thanخرويز the 10-fold costs في اهتورذ (being of comparison تغلبف( highest فاعصأا ininterventions Zurich 10 نم and ثركأا تلاخدتلا lowest variedin more ةنراقم Gro-
Costs
تلاخدتلا than ningen; 10-fold فيلاكت Table (being انعبات 2). Looking اذإا highest امأا .)2 in لودلجا only Zurich at رظنأا intervention and ؛نجنينورج lowest في costs, inاهتاجرد GroIPS
فيلاكتلا
ningen; was more Table expensive 2). Looking thanonly comparison at intervention services costs, in two IPSof
في تامدلخا نم اهيرغب ةنراقلماب Inpatient costs for the IPS group, which were some-
the sites, less expensive in the ًءلاغ ثركأا IPS لا نأا دجنص ,اهدحو
was more expensive than comparison four others. services in two of
what يتلاو higher ,IPS لا than ةعومجبم those ةصالخا for ةماقإلا the usual فيلاكت care اًيرثك group تصلقت atدقل base-
were some- the Table sites, less 3 presents expensive .ىرخأا عقاوم costs inةعبرأا summed the four في ًءلاغ others. over لقأاو 18عقاولما months, نم ينعقوم distin-
were
line, فيلاكت declined نم ثركأا ,ةيديلقتلا much more ةيانعلا than تاعوممج those فيلاكت for نم theىلعأا usual ام دح care
oup at somebase- ينب guishing Table قرفُيو 3,اًرهص presents between 18 لا costs للاخ intervention summed في فيلاكتلا over and لممج 18 other 3 months, لودلجا costs مدقب distin(aggre- ىلإا
group over the first 6 months following randomization,
eup usual at base- care ةدوقفلما guishinggated), ميقلا with between تلاخدم and without intervention نم لا ِكب imputations )ةعممج( and ىرخألا other forفيلاكتلاو missing costs values. تلاخدتلا (aggre- It رايتخلا دعب رهصأا ةتص لوأا دعب اميف كلذو ,ةيديلقتلا ةيانعلا تاعوممج
so that adjusted inpatient costs over the first 6 months
domization,
usual care gated), also presents with andtotal without costs imputations (includingfor imputations) missing values. by site. It
بصحب )تلاخدُلما لمصت يتلاو( ةيلكلا فيلاكتلا اصيأا مّدقُي ,اهنودبو
domization,
were للاخ significantly في هذه ةلدعُلما lower ةيلخادلا for ةماقإلا IPSفيلاكت than نأاف forلياتلابو the usual ,يئاوصعلا
st 6 months also Averaged presents across totalsites, costs IPS (including servicesimputations) cost £4022 less by site. than
care
t رخآل
e 6usual months care Averaged other عقوم vocational نم across فلتخي sites, services. لدعبم IPS IPS services Total لا تامدخ per cost person ةفلكت £4022 تغلب costs less دقل over .عقولما than18
group ةيديلقتلا (Table ةيانعلا 1). ةعوممج However, نم ثركأا the IPS difference لل نم لقأا تناك diminished رهصأا ةتص over لوأا
inished usual care over ,ىرخألا other months vocational فيظوتلا (adjusted تامدخ services. forنم baseline) لقأا Total لدعم per were وهو person significantly ينيلترصأا costs ةينج over lower 4,022 18 — the تناكو subsequent ,ةقحلالا رهصأا 6 months, ةتصلا للاخ and في قرفلا these اذه inpatient سّلقت دق نكل costs ,)1 لودج( were
nished t costsover were بصحب months by about اذهو( (adjusted one-third اًرهص 18 for لا — للاخ baseline) for في theدرف IPS were لكل group. فيلاكتلا significantly Including عوممج lower ناك imputa- دقو — virtually identical over the final 6 months. In contrast,
.ةيرخألا رهصأا ةتصلا للاخ في ةهباصتم هذه ةيلخادلا ةماقإلا فيلاكت
In costs contrast, were bytions about for one-third missing— values for theconfirmed IPS group. this. Including Totalimputa adjusted outpatient service costs (adjusted for baseline outpatient
ىلع رمألا اذه دكأا دقو ,عبرلا لياوحب IPS لا ةعومجلم اًيرثك لقأا )ساصألا
costs) في IPS were لا ةعومجلم greater ىلعأا for ينيجرالخا the IPS ىصرلما group فيلاكت overتناك the,لباقلمابو en outpatient contrast, tions costsfor were missing lower values for the confirmed IPS group this. at fiveTotal out of adjusted six sites
final 6-
لقأا ةئيهلما ةيلكلا فيلاكتلا تناك دقل .ةدوقفلما ميقلل ةنمصتُلما تلاخدُلما
the outpatient final 6-
costs were lower for the IPS group at five out of six sites month follow-up .لايئص ناك period, فلاتخلا but نأا لإا the,رهصأا difference ةتصلا ةعباتم was ةترف small. للاخ
hewas final small. 6-
عقاوم ةتص لصأا نم ةصمخ في IPS لا ةعومجلم
was small.
)£( عفدلا في ةبغرلا
)£( عفدلا في ةبغرلا
upport is cost- Figure 3 Probability (by site) that Individual Placement and Support
Figure 1 Probability that Individual Placement and Support is costge
pport of values is costof
Figure is cost-effective 3 Probability compared (by site) with thatvocational Individualservices Placement for and a range Support of valeffective
compared with vocational services for a range of values of
willingness ثيح نم ةلاعف to pay يدرفلا for anفيظوتلاو additional معدلا 1% تامدخ in people نأا working ةيلامتحأا at :1 least لكصلا
rking e of values at least of1
isues cost-effective of willingness compared to paywith for an vocational additional services 1% infor people a range working of valfor
1
ing at least 1 ues at least of willingness 1 day to pay for an additional 1% in people working for
فيظوتلاو معدلا تامدخ نأا )عقولما ثيح نم( ةيلامتحأا :3 لكصلا day ةبغرلا ميق نم ةعوممج سخي اميف فيظوتلا تامدخ عم ةنراقلماب ةفلكتلا
at least 1 day
سخي اميف فيظوتلا تامدخ عم ةنراقلماب ةفلكتلا ثيح نم ةلاعف يدرفلا 64 لقألا ىلع اًدحاو ا ًموي نولمعي نيذلا ساخصألال ةيفاصإا %1 عفد في
World Psychiatry 12:1 - February 2013
World Psychiatry 12:1 - February 2013
مويل نولمعي نيذلا دارفألال ةيفاصإا %1 عفد في ةبغرلا ميق نم ةعوممج
لقألا ىلع دحاو
Figure 2
effective
willingn
Total c
group
subseq
The
across
while t
than 1
ningen
was m
the site
Tabl
guishin
gated),
also pr
Averag
other v
month
by abo
tions f
costs w
Figure 3
is cost-e
ues of w
at least 1