Abstract
BackgroundStudies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents.AimsTo evaluate the cost-effectiveness of DBT for adolescents (DBT-A) compared to enhanced usual care (EUC).MethodsIn a randomised study, 77 adolescents with repeated self-harm were allocated to 19 weeks of outpatient treatment, either DBT-A (n = 39) or EUC (n = 38). Cost-effective analyses, including estimation of incremental cost-effectiveness ratios, were conducted with self-harm and global functioning (CGAS) as health outcomes.ResultsUsing self-harm as effect outcome measure, the probability of DBT being cost-effective compared to EUC increased with increasing willingness to pay up to a ceiling of 99.5% (threshold of € 1400), while with CGAS as effect outcome measure, this ceiling was 94.9% (threshold of € 1600).ConclusionsGiven the data, DBT-A had a high probability of being a cost-effective treatment.
Highlights
Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents
Main results of the efficacy study In the first 19 weeks, DBT for adolescents (DBT-A) was superior to enhanced usual care (EUC) in reducing the number of self-harm episodes and the level of suicidal ideation and depressive symptoms [15]
At 71 weeks, participants who had received DBT-A still had a statistically significantly larger reduction in self-harm episodes than participants in the EUC-group, for the other outcomes there were no longer significant differences; this was caused by EUC participants having reached an equal level of improvement over the 1 year follow-up interval [16]
Summary
Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents. Psychosocial treatments that effectively reduce self-harm in adolescents have only recently emerged. Such treatments seem to be characterised by a sufficient dose of treatment and family involvement [6]. Repeated self-harm is resource-demanding, as it involves a broad range of health services for shorter or longer periods of time. Studies of cost-effectiveness involve the systematic measurement of the inputs (treatment costs) and outcomes (health) of two alternative treatments, commonly the new experimental treatment and standard treatment. The subsequent comparative analysis provides decisionmakers with information on between-treatments differences with respect to costs and health effects. In the present study the cost-effectiveness of DBT-A is analyzed based on the incremental cost-effectiveness ratio (ICER), given by the ratio of between-group differences in costs and effects
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