Cost-Effectiveness of Community-Based Rehabilitation for People With Schizophrenia

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.