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

Autor:	Mavranezouli I; Research Department of Clinical, Educational & Health Psychology, University College London, London, UK i.mavranezouli@ucl.ac.uk., Pelone F; Royal College of Obstetricians and Gynaecologists, London, UK., Connolly R; National Institute for Health and Care Excellence, Manchester, UK., Mughal F; School of Medicine, Keele University, Keele, UK., Witt KG; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.; Orygen Ltd, Parkville, Victoria, Australia., Hawton K; Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK., Lascelles K; Oxford Health NHS Foundation Trust, Oxford, UK., Wildgoose A; South London and Maudsley NHS Foundation Trust, London, UK., Childs A; Berkshire Healthcare NHS Foundation Trust, Bracknell, UK., Pilling S; Research Department of Clinical, Educational & Health Psychology, University College London, London, UK.; Camden and Islington NHS Foundation Trust, London, UK., Kapur N; National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK.; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK.; Mersey Care NHS Foundation Trust, Liverpool, UK.
Jazyk:	angličtina
Zdroj:	BMJ mental health [BMJ Ment Health] 2024 Nov 05; Vol. 27 (1). Date of Electronic Publication: 2024 Nov 05.
DOI:	10.1136/bmjment-2024-301220
Abstrakt:	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. Competing Interests: Competing interests: IM, FP, RC and SP received support from the National Institute for Health and Care Excellence (NICE) for the submitted work. AW, AC, FM, KL and NK declared the following interests based on NICE’s policy on conflicts of interests:https://www.nice.org.uk/guidance/ng225/documents/register-of-interests. KH is a member of the National Suicide Prevention Strategy for England Advisory Group. The authors report no other relationships or activities that could appear to have influenced the submitted work. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)
Databáze:	MEDLINE
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