■个人安置和支持(IPS)是一种专业干预措施,旨在帮助人们在开放竞争的劳动力市场中获得就业。IPS已在严重精神疾病和其他残疾中开发,但它对酒精和药物依赖者的有效性未知。个人安置和支持酒精和药物(IPS-AD)是第一个评估有效性和成本效益的优势试验。
■IPS-AD是一个务实的,平行组,多中心,随机化,控制,标准就业支持(照常治疗[TAU])与IPS的3期试验。IPS作为单集提供长达13个月。这项研究是在英格兰的七个酒精和药物依赖社区治疗中心进行的。研究参与者是成年人(18-65岁),参加酒精使用障碍(AUD)治疗至少14天的人,阿片类药物使用障碍(OUD),或另一种药物使用障碍(DUD;主要是大麻和兴奋剂);失业或不从事经济活动至少六个月;并希望在开放竞争的劳动力市场中就业。在随机分配研究干预措施后,主要结果是18个月随访期间的就业,通过混合效应逻辑回归分析,使用多重插补来管理缺失的结果数据。有两个成本效益结果:健康结果表示为使用30,000英镑和70,000英镑支付意愿[WTP]阈值的质量调整生命年(QALY);以及额外的就业天数,WTP门槛为每天工作200英镑。该研究在ISRCTN(ISRCTN24159790)注册并完成。
■在2018年5月8日至2019年9月30日期间,确定了2781名潜在合格患者。812在筛查前被排除,1720名参与者被随机分配到TAU或IPS.在错误中,9名参与者两次被随机分组研究干预措施,因此对他们第一次随机分组的数据进行了分析(修改后的意向治疗).另有24名参与者撤回了对所有数据的同意(因此,完整分析集1687名参与者[70.1%男性;平均年龄40.8岁];TAU,n=844;IPS,n=843[AUD,n=610;OUD,n=837;DUD,n=240])。TAU组844名参与者中的559人[66.2%]获得了标准就业支持。IPS组843名参与者中有804人[95.37%]接受了IPS。与TAU相比,IPS与就业率增加相关(调整后比值比[OR]1.29;95%CI1.02-1.64;p值0.036)。IPS对AUD和DUD组有效(分别为OR1.48;95%CI1.14-1.92;p值0.004;OR1.45,95%CI1.03-2.04,p值0.031),但不是OUD组。IPS返回每位参与者的QALY结果增量为0.01(范围0.003-0.02),在任一WTP阈值下都没有成本效益的证据,但AUD和DUD组的QALY收益在£70,000WTP阈值下具有成本效益(概率分别为0.52和0.97)。IPS在额外的就业天数内具有成本效益(概率0.61),有效性仅与AUD组相关(概率>0.99)。39名参与者报告了严重不良事件(TAU组844名参与者中的13名[1.5%],IPS组43名参与者中的23名[2.7%])。共有25例死亡(1.5%;TAU组9例,IPS组16例)-没有人认为与研究干预有关。
■在酒精和药物依赖的IPS的第一个优势随机对照试验中,与标准的就业支持相比,IPS帮助更多的人在开放竞争的劳动力市场中就业。IPS对于AUD和DUD组的QALY健康结果(70,000英镑WTP阈值)具有成本效益,以及AUD组的额外就业天数(每天工作WTP阈值200英镑)。
■英国政府工作和健康单位。
UNASSIGNED: Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness.
UNASSIGNED: IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed.
UNASSIGNED: Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions.
UNASSIGNED: In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold).
UNASSIGNED: UK government Work and Health Unit.