The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia
Abstract
Abstract:Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI −223.7 to 73.3) and A$ 18.3M (95% UI −86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI −10.1 to 27.9), 2.5 in SA2 (95% UI −4.8 to 13.3), and 5.1 in SA3 (95% UI −9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.
References
(2021). Psychosocial interventions for self-harm in low-income and middle-income countries: Systematic review and theory of change. Social Psychiatry and Psychiatric Epidemiology, 56, 1729–1750. 10.1007/s00127-020-02005-5
(2017). Evolution of cognitive-behavioral therapy for eating disorders. Behaviour Research and Therapy, 88, 26–36. 10.1016/j.brat.2016.09.004
. (2016). 6306.0 Employee earnings and hours, Australia, June 2016. http://www.abs.gov.au/ausstats/[email protected]/mf/6306.0/
. (2020). Causes of death, Australia, 2019. https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2019
. (2019). Health expenditure Australia 2017–2018. https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2017-18/contents/summary
. (2020). Suicide and self-harm monitoring. https://www.aihw.gov.au/suicide-self-harm-monitoring
(1995). Cognitive therapy: Basics and beyond. Guilford Press.
(2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA, 294(5), 563–570. 10.1001/jama.294.5.563
(2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: Systematic review and meta-analysis. PLoS ONE, 9(2), Article
e89944 . 10.1371/journal.pone.0089944(2008). Priority setting in health: Origins, description and application of the Australian Assessing Cost–Effectiveness initiative. Expert Review of Pharmacoeconomics & Outcomes Research, 8(6), 593–617. 10.1586/14737167.8.6.593
(2017). Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? and Where? Evidence-Based Mental Health, 20(2), 35–40. 10.1136/eb-2017-102667
(2012). Cost of attempted suicide: A retrospective study of extent and associated factors. Swiss Medical Weekly, 142, Article
w13648 . 10.4414/smw.2012.13648(2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, Article
4 . 10.3389/fpsyt.2018.00004(2015). Training mental health professionals in suicide practice guideline adherence: Cost-effectiveness analysis alongside a randomized controlled trial. Journal of Affective Disorders, 186, 203–210. 10.1016/j.jad.2015.07.028
(2021). International study of definitions of English-language terms for suicidal behaviours: A survey exploring preferred terminology. BMJ Open, 11, Article
e043409 . 10.1136/bmjopen-2020-043409(2018). Modeling the cost-effectiveness of interventions to reduce suicide risk among hospital emergency department patients. Psychiatric Services, 69(1), 23–31. 10.1176/appi.ps.201600351
. (2019). Economic cost of suicide and deliberate self-harm in Northern Ireland. https://www.health-ni.gov.uk/sites/default/files/publications/health/pl2-eco_1.pdf
(2019). Screening and intervention for suicide prevention: a cost-effectiveness analysis of the ED-SAFE interventions. Psychiatric Services, 70(12), 1082–1087. 10.1176/appi.ps.201800445
(2016). Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis. The Lancet Psychiatry, 3(8), 740–750. 10.1016/S2215-0366(16)30070-0
(2017). The economic cost of suicide and non-fatal suicide behavior in the Australian workforce and the potential impact of a workplace suicide prevention strategy. International Journal of Environmental Research and Public Health, 14(4), Article
347 . 10.3390/ijerph14040347(2013). The economic cost of suicide in Australia. https://menslink.org.au/wp-content/uploads/2013/10/KPMG-Economic-cost-of-suicide-in-Australia-Menslink.pdf
(2014). Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies. PloS One, 9(1), Article
e84282 . 10.1371/journal.pone.0084282(2021). The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study. The Lancet Global Health, 9(3), e291–e300. 10.1016/s2214-109x(20)30493-9
(2017). Quality assessment of economic evaluations of suicide and self-harm interventions. Crisis, 39(2), 82–95. 10.1027/0227-5910/a000476
(2021). Improving suicide prevention through evidence-based strategies: a systematic review. American Journal of Psychiatry, 178(7), 611–624. 10.1176/appi.ajp.2020.20060864
(2015). Economic evaluations of interventions designed to prevent mental disorders: a systematic review. Early Intervention in Psychiatry, 9(2), 85–92. 10.1111/eip.12156
(2019). The economic case for investing in mental health prevention. National Mental Health Commission. https://www.mentalhealthcommission.gov.au/getmedia/ffbf9cc5-f815-4034-b931-dfc0c1ecb849/The-economic-case-for-investing-in-mental-health-prevention
. (2011). The economic analysis of prevention in mental health programs. Annual Review of Clinical Psychology. 7, 169–201. https://doi.org/10.1146/annurev-clinpsy-032210-104601.
(2005). The cost of suicide to society. Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/thecostofsuicidetosociety.pdf
(2018). Cost-effectiveness of a brief structured intervention program aimed at preventing repeat suicide attempts among those who previously attempted suicide: a secondary analysis of the ASSIP randomized clinical trial. JAMA Network Open, 1(6), Article
e183680 . 10.1001/jamanetworkopen.2018.3680(2020). Suicide prevention programs. Crisis, 41(Suppl1), S99–S124. 10.1027/0227-5910/a000671
. (2020). Mental health, Report no. 95. https://www.pc.gov.au/inquiries/completed/mental-health/report
(2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. 10.1017/S0033291715001804
(2015). e-CBT (myCompass), antidepressant medication, and face-to-face psychological treatment for depression in Australia: A cost-effectiveness comparison. Journal of Medical Internet Research, 17(11), Article
e255 . 10.2196/jmir.4207(2020). Improving cost-effectiveness and access to cognitive behavior therapy for depression: Providing remote-ready, computer-assisted psychotherapy in times of crisis and beyond. Psychotherapy and Psychosomatics, 89(5), 307–313. 10.1159/000508143
(2012). Reducing suicidal ideation: Cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help. Journal of Medical Internet Research, 14(5), Article
e141 . 10.2196/jmir.1966(2011). Disability weights for suicidal thoughts and non-fatal suicide attempts. Journal of Affective Disorders, 134(1-3), 341–347. 10.1016/j.jad.2011.05.020
(2010). Assessing Cost-Effectiveness in Prevention (ACE-Prevention): Final Report. University of Queensland, Brisbane and Deakin University. https://public-health.uq.edu.au/files/571/ACE-Prevention_final_report.pdf
(2005). Cost-effectiveness of cognitive–behavioural therapy and drug interventions for major depression. Australian & New Zealand Journal of Psychiatry, 39(8), 683–692. 10.1080/j.1440-1614.2005.01652.x
(2021). Psychosocial interventions for self-harm in adults. Cochrane Database of Systematic Reviews, 2016(5), Article
CD012189 . 10.1002/14651858.CD012189. (2016). Preventing suicide: A global imperative. https://www.who.int/publications/i/item/9789241564779
. (2019). An overview of the rationale, activities and goals of WHO-CHOICE. https://www.who.int/choice/description/importance/en/
. (2021). Suicide worldwide in 2021 Global health estimates. https://www.who.int/publications/i/item/9789240026643
(2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659. 10.1016/S2215-0366(16)30030-X
(2019). Psychosocial suicide prevention interventions in the elderly: A mini-review of the literature. Frontiers in Psychology, 9, Article
2713 . 10.3389/fpsyg.2018.02713(1988). What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. Journal of the American Medical Association, 280(19), 1690–1691. 10.1001/jama.280.19.1690
