The effect of employment support integrated in substance use treatment: A health economic cost-effectiveness simulation of three different interventions

Abstract

Background: Unemployment rates for individuals in treatment for substance use disorder (SUD) are high, with Norwegian estimates in the range of 81%–89%. Although Individual Placement and Support (IPS) represents a promising method to improved vocational outcome, cross-disciplinary investigations are needed to document implementation benefits and address reimbursements needs. The aim of this study was to model the potential socioeconomic value of employment support integrated in SUD treatment. Methods: Based on scientific publications, an ongoing randomised controlled trial (RCT) on employment support integrated in SUD treatment, and publicly available economy data, we made qualified assumptions about costs and socioeconomic gain for the different interventions targeting employment for patients with SUD: (1) treatment as usual (TAU); (2) TAU and a self-help guide and a workshop; and (3) TAU and IPS. For each intervention, we simulated three different outcome scenarios based on 100 patients. Results: Assuming a 40% employment rate and full-time employment (100%) for 10 years following IPS, we found a 10-year socioeconomic effect of €18,732,146. The corresponding effect for the more conservative TAU + IPS simulation assuming 40% part-time positions (25%) for five years, was €2,519,906. Compared to the two alternative interventions, IPS was cost-effective and more beneficial after six months to two years. Discussion: This concept evaluation study suggests that integrating employment support in the health services is socioeconomically beneficial. Our finding is relevant for decision makers within politics and health. Once employment rates from our ongoing RCT is available, real-life data will be applied to adjust model assumptions and socioeconomic value assumptions.

Wellness in work - supporting people in work and assisting people to return to the workforce: An economic evidence review

“…Three scenarios were compared: treatment as usual (TAU), a self- guide and workshop with TAU, and TAU and individual placement support (IPS). IPS was found to be more effective and cost-effective after 6 months to 2 years in comparison to the two other interventions (Rognli et al, 2023).…”

“…Literature searches identified two economic evaluations and two systematic reviews exploring the cost-effectiveness of interventions targeting substance abuse to improve work-related outcomes (de Oliveira et al, 2020; Morse et al, 2022; Orme et al, 2023; Rognli et al, 2023).…”

“…In Norway, a cost-effectiveness simulation study based on previously published data was conducted to estimate the costs and outcomes of employment support integrated into substance abuse treatment (Rognli et al, 2023). Three scenarios were compared: treatment as usual (TAU), a self- guide and workshop with TAU, and TAU and individual placement support (IPS).…”

Labour market integration of adults with alcohol and substance use problems in the Nordic countries

“…Additionally, it contributes to both inancial and social advantages, which in turn enhance the capacities associated with social participation and active citizenship (Berkman, 2014). These bene its arguably apply to individuals struggling with alcohol and substance use, too, but they are often excluded from working life (Rognli et al, 2023). Furthermore, unemployment poses a signi icant challenge to the inancial sustainability of modern welfare states.…”

Alcohol, drugs, tobacco and gambling form a lens for the Nordic welfare states’ biggest challenges

“… Koponen and colleagues (2023) have compared adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure. In an overview report, Rognli and colleagues (2023) compare intervention simulations of employment support integrated in the treatment for substance use.…”