BMJ Ment Health. 2024 Nov 5;27(1):e301220. doi: 10.1136/bmjment-2024-301220.
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.
PMID:39500599 | DOI:10.1136/bmjment-2024-301220
