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

Byford, S., Knapp, M., Greenshields, J., Ukoumunne, O. C., Jones, V., Thompson, S., Tyrer, P., Schmidt, U. and Davidson, K. (2003) Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach. Psychological Medicine, 33(6), pp. 977-986. (doi:10.1017/S0033291703008183)

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Publisher's URL: http://dx.doi.org/10.1017/S0033291703008183

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Davidson, Professor Kate
Authors: Byford, S., Knapp, M., Greenshields, J., Ukoumunne, O. C., Jones, V., Thompson, S., Tyrer, P., Schmidt, U., and Davidson, K.
College/School:College of Medical Veterinary and Life Sciences
Journal Name:Psychological Medicine
ISSN:0033-2917

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