Cost-Effectiveness of Community-Based Rehabilitation for People With Schizophrenia: A Secondary Analysis of a Cluster Randomized Trial
In brief
Community rehab saves roughly $25,000 per quality-adjusted life year for schizophrenia in China
Adding a year-long group-based community rehabilitation program to standard psychiatric care improved symptoms, social functioning, and caregiver burden while cutting costs, yielding savings of about $25,000 per QALY gained. The analysis showed a >90% chance of cost-effectiveness, suggesting the model could be scaled in low-resource settings, though long-term outcomes remain to be studied.
- Journal
- JAMA health forum (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ruoxi Ding, Miaomiao Zhao, Yanshang Wang, Yiqi Xia, Xiaolong Guan, Zhenyu Shi, et al.
- PMID
- 42758489
- DOI
- 10.1001/jamahealthforum.2026.3280
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (top studies of the week, 20 September 2026): Cost‑effectiveness of community rehab for schizophrenia
Abstract
IMPORTANCE: Schizophrenia imposes a substantial disease burden in resource-constrained settings such as China, yet rigorous evidence on the cost-effectiveness of community-based rehabilitation (CBR) remains limited. OBJECTIVE: To evaluate the cost-effectiveness of a group-based CBR intervention plus facility-based care (FBC) compared with FBC alone for adults with schizophrenia in China. DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis evaluated a cluster randomized trial conducted across 18 urban and rural subdistricts in Weifang, Shandong Province, China, from March 2023 to October 2024. Participants were community-dwelling, clinically stable adults aged 18 to 59 years with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of schizophrenia and illness duration of at least 12 months. INTERVENTION: The CBR program comprised 18 group sessions over 12 months (12 biweekly sessions, then 6 monthly sessions) covering psychoeducation, medication adherence, physical health promotion (including tai chi), life and social skills training, and caregiver support. FBC consisted of psychiatrist-led medication management and monthly consultations. MAIN OUTCOMES AND MEASURES: The main outcomes were incremental cost per quality-adjusted life-year (QALY) gained and per-unit improvement in symptom severity (Positive and Negative Syndrome Scale [PANSS]), social functioning (Personal and Social Performance Scale [PSP]), and caregiver burden (Burden Assessment Scale [BAS]), assessed from health care system, multipayer, and societal perspectives. RESULTS: A total of 334 participants were enrolled and randomized; 172 were randomized to CBR plus FBC and 162 to FBC alone. At 12 months, 161 participants (93.6%) and 154 participants (95.0%) were retained, respectively. Mean (SD) baseline age was 46.7 (9.3) years; 180 participants (53.9%) were male; 204 (61.1%) resided in rural areas. CBR was associated with significantly improved clinical outcomes and lower costs at 12 months. Incremental cost-effectiveness ratios indicated savings of $24 636 to $27 847 per QALY gained across perspectives, with $20.70 to $46.90 saved per unit improvement in PANSS, PSP, and BAS scores. The probability of cost-effectiveness ranged from 91.0% to 98.7% for QALYs and exceeded 95% for clinical outcomes at derived threshold values of $24.30 to $52.00 per unit. Sensitivity analyses confirmed robustness. CONCLUSIONS AND RELEVANCE: In this secondary analysis of a cluster randomized trial, group-based CBR for schizophrenia in China was associated with improved outcomes and a high probability of cost savings, supporting its scaled implementation in resource-constrained settings. TRIAL REGISTRATION: ChiCTR.org.cn Identifier: ChiCTR2200066945.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.