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BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Study protocol

Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol

Authors: Sarita A. Sanches, Wilma E. Swildens, Jooske T. van Busschbach, A. Dennis Stant, Talitha L. Feenstra, Jaap van Weeghel

Published in: BMC Psychiatry | Issue 1/2015

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Abstract

Background

People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT’s) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial.

Methods

In a multisite RCT, 225 adults (18–64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios.

Discussion

The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make decisions about further implementation of the method. Also, assessing budgetary impact will facilitate policymaking. The large sample size, geographic coverage and heterogeneity of the study group will ensure reliable generalisation of the study results.

Trial registration

Current Controlled Trials: ISRCTN88987322. Registered 13 May 2014.
Footnotes
1
Until January 1st 2014, 65 years was the retirement age in the Netherlands. After this date, retirement age is gradually being increased to 67 years. In our experience, older patients usually have different goals in societal participation – most noticeably, other than obtaining regular employment. We therefore decided to set the maximum age at 64.
 
2
Patients with Anorexia Nervosa are often hospitalised for extreme underweight. These patients are often young and in order to promote a smooth transition from hospitalisation to normal life, rehabilitation is started during hospitalisation. We therefore decided to include inpatients with Anorexia Nervosa. Inpatients must be in the last phase of inpatient treatment and the date of discharge must have been set.
 
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Metadata
Title
Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol
Authors
Sarita A. Sanches
Wilma E. Swildens
Jooske T. van Busschbach
A. Dennis Stant
Talitha L. Feenstra
Jaap van Weeghel
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0593-8

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