Cost-effectiveness of the SMILE intervention compared with usual care for people with severe mental illness: A randomized clinical trial
2025

Cost-Effectiveness of the SMILE Intervention for Severe Mental Illness

Sample size: 224 publication 10 minutes Evidence: moderate

Author Information

Author(s): El Alili Mohamed, van Meijel Berno, van Tulder Maurits W., Adriaanse Marcel

Primary Institution: Vrije Universiteit Amsterdam, Faculty of Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

Hypothesis

The study aims to evaluate the cost-effectiveness of a lifestyle intervention for people with severe mental illness compared to usual care.

Conclusion

The SMILE intervention resulted in lower total costs compared to usual care and was cost-effective for body weight change, but not for quality-adjusted life years (QALYs).

Supporting Evidence

  • The SMILE intervention led to a weight loss of -3.76 kilograms compared to usual care.
  • Total societal costs were €690 lower in the intervention group compared to usual care.
  • The intervention was dominant for body weight change, indicating better outcomes at lower costs.
  • Quality of life measured by QALYs did not show significant improvement.
  • Costs for home care were significantly lower in the intervention group.

Takeaway

The SMILE program helps people with severe mental illness lose weight and costs less than regular care, but it doesn't improve their quality of life.

Methodology

A pragmatic cluster randomized controlled trial was conducted with a one-year follow-up, assessing costs, body weight change, and quality of life.

Potential Biases

Potential bias due to the exclusion of an outlier and the reliance on self-reported data.

Limitations

The sample size was smaller than planned, and an outlier significantly influenced the results.

Participant Demographics

Participants were adults (18 years or older) with a BMI of 27 or higher receiving care from FACT-teams in the Netherlands.

Statistical Information

P-Value

0.037

Confidence Interval

95% CI -6.30; -1.23

Statistical Significance

p<0.05

Digital Object Identifier (DOI)

10.1371/journal.pone.0313100

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