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

Published online by Cambridge University Press:  31 July 2003

S. BYFORD
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
M. KNAPP
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
J. GREENSHIELDS
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
O. C. UKOUMUNNE
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
V. JONES
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
S. THOMPSON
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
P. TYRER
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
U. SCHMIDT
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge
K. DAVIDSON
Affiliation:
Department of Psychological Medicine, Imperial College, King's College and Maudsley Hospitals and the Centre for the Economics of Mental Health, Institute of Psychiatry, London: Gartnavel Royal and Southern General Hospital, Glasgow; Royal Edinburgh Hospital, Edinburgh; Stonebridge Research Centre and Queen's Medical Centre, Nottingham; Maidstone General Hospital, Maidstone; and MRC Biostatistics Unit, Cambridge

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.

Type
Research Article
Copyright
© 2003 Cambridge University Press

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