Abstract
Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. There is some evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm, but the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm is unknown. A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over 2years. Data on risk of subsequent self-harm and hospital costs of treating self-harm were drawn from the Multicentre Study of Self-Harm in England, while estimates of effectiveness of psychosocial assessment on risk of self-harm, quality of life, and other costs were drawn from literature. Incremental cost-effectiveness ratios (ICERs) for cost per Quality Adjusted Life Year (QALY) gained were estimated. Parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses. Cost per QALY gained from psychosocial assessment was £10,962 (95% uncertainty interval [UI] £15,538-£9,219) from the National Health Service (NHS) perspective and £9,980 (95% UI £14,538-£6,938) from the societal perspective. Results were generally robust to changes in model assumptions. The probability of the ICER being below £20,000 per QALY gained was 78%, rising to 91% with a £30,000 threshold. Psychosocial assessment as implemented in the English NHS is likely to be cost-effective. This evidence could support adherence to NICE guidelines. However, further evidence is needed about the precise impacts of psychosocial assessment on self-harm repetition and costs to individuals and their families beyond immediate hospital stay.
Highlights
Self-harm, defined as nonfatal intentional self-poisoning or self-injury, irrespective of degree of suicidal intent or other motives [1,2], is a major health care problem globally
From an National Health Service (NHS) perspective adherence to guidance on psychosocial assessment would potentially be cost-effective with a cost per Quality Adjusted Life Year (QALY) gained of £10,962 (95% uncertainty interval [UI], £15,538–£9,219) (Table 2)
When immediate productivity losses restricted only to inpatient time in hospital are included, incremental cost per QALY gained falls to £9,980 (95% UI, £14,538, £6,938). These are below the notional £20,000 cost per QALY gained threshold that is one of the factors taken into account in deliberations by NICE before making recommendations on the reimbursement of health technologies and public health interventions
Summary
Self-harm, defined as nonfatal intentional self-poisoning or self-injury, irrespective of degree of suicidal intent or other motives [1,2], is a major health care problem globally. Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. Data on risk of subsequent self-harm and hospital costs of treating self-harm were drawn from the Multicentre Study of Self-Harm in England, while estimates of effectiveness of psychosocial assessment on risk of self-harm, quality of life, and other costs were drawn from literature. Cost per QALY gained from psychosocial assessment was £10,962 (95% uncertainty interval [UI] £15,538–£9,219) from the National Health Service (NHS) perspective and £9,980 (95% UI £14,538–£6,938) from the societal perspective. Psychosocial assessment as implemented in the English NHS is likely to be costeffective This evidence could support adherence to NICE guidelines. Further evidence is needed about the precise impacts of psychosocial assessment on self-harm repetition and costs to individuals and their families beyond immediate hospital stay
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