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Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach

  • S. BYFORD (a1), M. KNAPP (a1), J. GREENSHIELDS (a1), O. C. UKOUMUNNE (a1), V. JONES (a1), S. THOMPSON (a1), P. TYRER (a1), U. SCHMIDT (a1), K. DAVIDSON (a1) and (ON BEHALF OF THE POPMACT GROUP)...

Abstract

Background. Deliberate self-harm can be costly, in terms of treatment and subsequent suicide. Any intervention that reduces episodes of self-harm might therefore have a major impact on the costs incurred by service providers and the productivity losses due to illness or premature death.

Method. Four hundred and eighty patients with a history of recurrent deliberate self-harm were randomized to manual-assisted cognitive behaviour therapy (MACT) or treatment as usual. Economic data were collected from patients at baseline, 6 and 12 months, and these data were complete for 397 patients. Incremental cost-effectiveness was explored using the primary outcome measure, proportion of patients having a repeat episode of deliberate self-harm, and quality of life. The uncertainty surrounding costs and effects was represented using cost-effectiveness acceptability curves.

Results. Differences in total cost per patient were statistically significant at 6 months in favour of MACT (−£897, 95% CI −1747 to −48, P=0·04), but these differences did not remain significant at 12 months (−£838, 95% CI −2142 to 466, P=0·21). Nevertheless, exploration of the uncertainty surrounding these estimates suggests there is >90% probability that MACT is a more cost-effective strategy for reducing the recurrence of deliberate self-harm in this population over 1 year than treatment as usual. The results for quality of life were not conclusive.

Conclusion. Cost-effectiveness acceptability curves demonstrate that, based on the evidence currently available, to reject MACT on traditional grounds of statistical significance and to continue funding current practice has <10% chance of being the correct decision in terms of cost-effectiveness.

Copyright

Corresponding author

Ms S. Byford, Box 24, Centre for the Economics of Mental Health, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.

Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach

  • S. BYFORD (a1), M. KNAPP (a1), J. GREENSHIELDS (a1), O. C. UKOUMUNNE (a1), V. JONES (a1), S. THOMPSON (a1), P. TYRER (a1), U. SCHMIDT (a1), K. DAVIDSON (a1) and (ON BEHALF OF THE POPMACT GROUP)...

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