Economic evaluation of a stigma awareness intervention on reemployment of people with mental illness: results from a cluster randomized controlled trial

Background: People with mental illness are more often unemployed, which may party be explained by the stigma attached to mental illness. Both unemployment and mental ill-health is associated with high economic and societal costs. In this study the costs and benefits of implementing a stigma awareness intervention into vocational rehabilitation is investigated.
Methods: In a cluster randomized controlled trial, 119 unemployed people with mental illness were allocated into two groups: (a) vocational rehabilitation as usual and (b) vocational rehabilitation combined with a stigma awareness intervention. Primary outcomes were finding and retaining employment and becoming independent of social benefits. These data were extracted from nationwide registers over 12 months. Using self-report healthcare costs and quality-adjusted life years were assessed at baseline, 3, 6 and 12 months.
Results: Participants of the intervention group had better work participation outcomes and better outcomes concerning becoming independent of social benefits than participants of the control group. For participants of the control group, mean total costs for social benefits and healthcare costs together were €11,228 (SD=€6,451, IQR=€6,367-€14,324). For the intervention group, mean total costs for social benefits, healthcare costs and intervention costs were €9,893 (SD=€5,181, IQR=€5,187-€13,745; p=0.411, d=0.080). However, the differences in these costs and use were not statistical significant.
Conclusions: Although the intervention is not cost-effective, implementing a stigma awareness intervention may be beneficial for unemployed people with mental illness, as it is not more expensive than vocational rehabilitation as usual.