Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis

Abstract

Aims There are substantial costs to health care systems and society associated with self-harm. Moreover, individuals who have presented to hospital following self-harm have a much higher risk of suicide within the following year compared to the general population. National guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence to this guidance is variable. There is some limited evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm. The aim of this study was to assess the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm in England compared to no assessment. Methods. We constructed a three-state four-cycle Markov model to assess the cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over two years. Data on risk of subsequent self-harm and hospital costs of treating different types of self-harm were drawn from prior analysis of the Multicentre Study of Self-Harm in England, while estimates of the effectiveness of psychosocial assessment on risk of self-harm, quality of life impacts and other costs were supplemented by a literature review. Incremental cost-effectiveness ratios (ICERs) were estimated in terms of cost per Quality Adjusted Life Year (QALY) gained and parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses. Costs were reported in 2020 UK Pounds (GBP) from the healthcare and societal perspective (that included productivity loss) and a discount rate of 3.5% was applied to future costs and QALYs. Results. The cost per QALY gained from psychosocial assessment was GBP 10,962 (95% uncertainty interval (UI) GBP 15,538 - GBP 9,219) from the NHS perspective, and GBP 9,980 (95% UI GBP 14,538, GBP 6,938) from the societal perspective. Baseline results were generally robust to changes in model assumptions; the relative risk of self-harm after psychosocial assessment would have to be 0.73 or lower for the ICER to be below GBP 20,000. The cost-effectiveness acceptability curve showed that the probability of the ICER to be below a GBP 20,000 threshold was 78%, rising to 91% with a GBP 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 still needed about the precise impact of psychosocial assessment on self-harm repetition and costs to individuals affected by self-harm and their families beyond immediate hospital stay.

Cost-effectiveness of implementing a suicide prediction tool (OxMIS) in severe mental illness: Economic modeling study

“…Overall, the results contribute to existing evidence suggesting the economic benefits of suicide prevention measures [26] and the cost-effectiveness of psychosocial assessment in preventing repeat self-harm [32]. We did not identify any previous research has been previously conducted on the cost-effectiveness of suicide risk prediction tools.…”

“…Overall, the results contribute to existing evidence suggesting the economic benefits of suicide prevention measures (24) and the cost-effectiveness of psychosocial assessment in preventing repeat self-harm. (30) We did not identify any previous research has been previously conducted on the costeffectiveness of suicide risk prediction tools. Such tools may have synergetic effects when combined with other secondary care suicide prevention measures that have been found to be cost-effective.…”