Cost-effectiveness of psychological and psychosocial interventions for adults, children and young people who have self-harmed
Year: 2024
Type: article
Abstract: BACKGROUND: Self-harm is a major health issue resulting in high societal costs. Few psychological and psychosocial interventions have shown effectiveness in reducing repeat self-harm. OBJECTIVE: To assess the cost-effectiveness of psychological and psychosocial interventions that have shown evidence of effectiveness in adults and CYP (children and young people) who have self-harmed. METHODS: Using effectiveness data from Cochrane reviews, we developed two decision-analytical models to compare costs and quality-adjusted life years (QALYs) of cognitive behavioural therapy (CBT)-informed psychological therapy added to treatment as usual (TAU) versus TAU alone for adults who have self-harmed, and of dialectical behavioural therapy for adolescents (DBT-A) versus enhanced TAU for CYP who have self-harmed, respectively, from a National Health Service and personal social services perspective in England. Other model input parameters were obtained from published sources, supplemented by expert opinion. FINDINGS: The incremental cost-effectiveness ratio (ICER) of CBT-informed psychological therapy added to TAU versus TAU alone for adults who have self-harmed was £9088/QALY. The ICER of DBT-A versus enhanced TAU for CYP who have self-harmed was £268 601/QALY. Results were overall robust to the alternative scenarios tested. CONCLUSIONS AND CLINICAL IMPLICATIONS: CBT-informed psychological therapy appears to be cost-effective for adults who have self-harmed, which contributes to evidence for its implementation in services. Currently, DBT-A does not seem to be cost-effective for CYP who have self-harmed. The economic analyses were informed by clinical evidence of moderate-to-low (CBT) and low (DBT-A) quality. Further clinical and economic evidence for DBT-A and other psychological and psychosocial interventions for people who have self-harmed is required.
Source: BMJ Mental Health
Authors: Ifigeneia Mavranezouli, Ferruccio Pelone, Rachel Connolly, Faraz Mughal, Katrina G Witt, Keith Hawton, Karen Lascelles, Amanda Wildgoose, Angela Childs, Stephen Pilling, Navneet Kapur
Institutions: University College London, Royal College of Obstetricians and Gynaecologists, National Institute for Health and Care Excellence, Keele University, The University of Melbourne, Orygen, University of Oxford, Oxford Health NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, Berkshire Healthcare NHS Foundation Trust, Camden and Islington NHS Foundation Trust, University of Manchester, Mersey Care NHS Trust
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4404065779