The cost-effectiveness of supported employment for adults with autism in the United Kingdom.
Bottom Line: Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year.In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost).Further research needs to confirm these findings.
Affiliation: University College London, UK email@example.com.Show MeSH
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Mentions: A simple decision-tree followed by a two-state Markov model was constructed using Microsoft Excel XP in order to assess the costs and outcomes associated with provision of supported employment versus standard care in adults with autism actively seeking employment. The structure and parameters of the decision-tree were determined by data reported in Mawhood and Howlin (1999). According to the decision-tree structure, adults with autism seeking employment were offered either supported employment or standard care (day services) over 17 months on average. As a result, a number of participants in each group found paid employment. Subsequently, a Markov model was developed to estimate the number of adults being in employment every year, from endpoint of the decision-tree (i.e. from the end of provision of the intervention) and up to 8 years, using the 8-year follow-up data reported in Howlin et al. (2005). The Markov model, which was run in yearly cycles, consisted of the states of ‘employed’ and ‘unemployed’. Each year every individual moved between the ‘employed’ and ‘unemployed’ states or remained in their current state. People in the ‘unemployed’ state of the Markov model in both arms of the analysis (i.e. people who had received supported employment and those who had received standard care while in the decision-tree) received standard care (day services). People in the ‘employed’ state of the Markov model spent only a proportion of each year (and not the full year) in employment. A schematic diagram of the economic model is presented in Figure 1.
Affiliation: University College London, UK firstname.lastname@example.org.