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


METHODS
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 (pounds sterling -897, 95 % CI -1747 to -48, P=0.04), but these differences did not remain significant at 12 months (pounds sterling -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.


CONCLUSIONS
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.
Byford
S
S
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals, Center for the Economics of Mental Health, Institute of Psychiatry, London.
Knapp
M
M
Greenshields
J
J
Ukoumunne
O C
OC
Jones
V
V
Thompson
S
S
Tyrer
P
P
Schmidt
U
U
Davidson
K
K
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000191:economics* / Q000534:rehabilitation / Q000628:therapy*