Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis
Abstract Background 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, b...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2022-01-01
|
| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822000050/type/journal_article |
| _version_ | 1811156331352031232 |
|---|---|
| author | David McDaid A-La Park Apostolos Tsiachristas Fiona Brand Deborah Casey Caroline Clements Galit Geulayov Nav Kapur Jennifer Ness Keith Waters Keith Hawton |
| author_facet | David McDaid A-La Park Apostolos Tsiachristas Fiona Brand Deborah Casey Caroline Clements Galit Geulayov Nav Kapur Jennifer Ness Keith Waters Keith Hawton |
| author_sort | David McDaid |
| collection | DOAJ |
| description |
Abstract
Background
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.
Methods
A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over 2 years. 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.
Results
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.
Conclusions
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.
|
| first_indexed | 2024-04-10T04:49:42Z |
| format | Article |
| id | doaj.art-bf8bf3446cd34830a5ca00ee67737a0d |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-04-10T04:49:42Z |
| publishDate | 2022-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-bf8bf3446cd34830a5ca00ee67737a0d2023-03-09T12:33:56ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-01-016510.1192/j.eurpsy.2022.5Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysisDavid McDaid0https://orcid.org/0000-0003-0744-2664A-La Park1https://orcid.org/0000-0002-4704-4874Apostolos Tsiachristas2https://orcid.org/0000-0002-4662-8915Fiona Brand3https://orcid.org/0000-0002-8304-0678Deborah Casey4Caroline Clements5https://orcid.org/0000-0003-4735-6728Galit Geulayov6https://orcid.org/0000-0002-4093-5156Nav Kapur7https://orcid.org/0000-0002-3100-3234Jennifer Ness8https://orcid.org/0000-0002-7445-4510Keith Waters9https://orcid.org/0000-0002-5031-0870Keith Hawton10https://orcid.org/0000-0003-4985-5715Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United KingdomCare Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United KingdomHealth Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United KingdomCentre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom Oxford Health NHS Foundation Trust, Oxford, United KingdomCentre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United KingdomCentre for Mental Health and Safety, University of Manchester, Manchester, United KingdomCentre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United KingdomCentre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United KingdomCentre for Self-Harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, United KingdomCentre for Self-Harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation Trust, Derby, United KingdomCentre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom Oxford Health NHS Foundation Trust, Oxford, United Kingdom Abstract Background 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. Methods A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over 2 years. 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. Results 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. Conclusions 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. https://www.cambridge.org/core/product/identifier/S0924933822000050/type/journal_articleEconomic issuesemergency departmentshealth economicshealth services researchsuicide |
| spellingShingle | David McDaid A-La Park Apostolos Tsiachristas Fiona Brand Deborah Casey Caroline Clements Galit Geulayov Nav Kapur Jennifer Ness Keith Waters Keith Hawton Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis European Psychiatry Economic issues emergency departments health economics health services research suicide |
| title | Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis |
| title_full | Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis |
| title_fullStr | Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis |
| title_full_unstemmed | Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis |
| title_short | Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: A model-based retrospective analysis |
| title_sort | cost effectiveness of psychosocial assessment for individuals who present to hospital following self harm in england a model based retrospective analysis |
| topic | Economic issues emergency departments health economics health services research suicide |
| url | https://www.cambridge.org/core/product/identifier/S0924933822000050/type/journal_article |
| work_keys_str_mv | AT davidmcdaid costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT alapark costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT apostolostsiachristas costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT fionabrand costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT deborahcasey costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT carolineclements costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT galitgeulayov costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT navkapur costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT jenniferness costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT keithwaters costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis AT keithhawton costeffectivenessofpsychosocialassessmentforindividualswhopresenttohospitalfollowingselfharminenglandamodelbasedretrospectiveanalysis |