Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm

• Published in: BJPsych open 2023-08, Vol.9 (5), p.e139-e139, Article e139
• Main Authors: Le, Long Khanh-Dao, Flego, Anna, Krysinska, Karolina, Andriessen, Karl, Bandara, Piumee, Page, Andrew, Schlichthorst, Marisa, Pirkis, Jane, Mihalopoulos, Cathrine, Carter, Greg, Reifels, Lennart
• Format: Article
• Language: English
• Subjects: Cost analysis; Cost control; Economic models; Emergency medical care; Estimates; Intervention; Mental Health Services; Meta-analysis; Planning; Prevention; Risk factors; Self destructive behavior; Sensitivity analysis; Suicide; Suicides & suicide attempts
• ISSN: 2056-4724; 2056-4724
• DOI: 10.1192/bjo.2023.525

Prior self-harm represents the most significant risk factor for future self-harm or suicide. To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.