Cost-effectiveness of psychological and psychosocial interventions for adults, children and young people who have self-harmed

Mavranezouli, Ifigeneia; Pelone, Ferruccio; Connolly, Rachel; Mughal, Faraz; Witt, Katrina G; Hawton, Keith; Lascelles, Karen; Wildgoose, Amanda; Childs, Angela; Pilling, Stephen; Kapur, Navneet

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.

Citation

Mavranezouli, I., Pelone, F., Connolly, R., Mughal, F., Witt, K. G., Hawton, K., …Kapur, N. (2024). Cost-effectiveness of psychological and psychosocial interventions for adults, children and young people who have self-harmed. BMJ Mental Health, 27(1), https://doi.org/10.1136/bmjment-2024-301220

• Journal Article Type: Article
• Acceptance Date: Oct 8, 2024
• Online Publication Date: Nov 5, 2024
• Publication Date: Nov 5, 2024
• Deposit Date: Nov 11, 2024
• Publicly Available Date: Nov 11, 2024
• Journal: BMJ Mental Health
• Electronic ISSN: 2755-9734
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 1
• DOI: https://doi.org/10.1136/bmjment-2024-301220
• Keywords: Data Interpretation, Statistical, Suicide & self-harm
• Public URL: https://keele-repository.worktribe.com/output/974643
• Publisher URL: https://mentalhealth.bmj.com/content/27/1/e301220