Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Epidemiol Psychiatr Sci. 2020 Mar 12;29:e108. doi: 10.1017/S2045796020000189.
The aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England.
We used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England.
There were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40-49 years (30%) for men and 19-29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8-140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results.
The results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm.
本研究旨在评估英格兰各地医院就诊的自伤发生率及其相关的医院成本。
我们使用了 2013 年在牛津、曼彻斯特和德比的五家综合医院急诊科就诊的所有自伤患者的多中心英格兰自伤研究的个体患者数据。我们还从牛津和德比的医院获得了每次自伤就诊的成本数据，以及英国国家统计局的人口和地理估计数据。首先，我们根据多中心研究估计了按年龄和性别划分的自伤就诊率，并将其乘以各自的人口数，以估算英格兰每个地方临床委托组（CCG）地区的按年龄和性别划分的自伤就诊人数。其次，我们对牛津和德比的成本数据进行了回归分析，以预测曼彻斯特按年龄、性别、接受心理社会评估、住院和自伤类型划分的自伤医院成本。第三，将每个年龄组的平均医院成本和性别与各自的自伤就诊人数相结合，以估算英格兰每个 CCG 的总医院成本。为了解决因将自伤发生率和成本从多中心研究外推到英格兰而导致的结果不确定性，我们进行了敏感性分析。
2013 年，英格兰有 228075 次估计的自伤就诊（61%为女性），涉及 159857 名患者。自伤就诊比例最大的年龄组是男性的 40-49 岁（30%）和女性的 19-29 岁（28%）。2013 年，相关医院费用约为 1.286 亿英镑（95%CI 117.8-140.9）。在英格兰的大多数沿海地区，自伤的发生率和相关的医院费用都较低，而内陆地区则较高，但大伦敦地区的费用最高。与较富裕的地区相比，该国社会经济较贫困地区的费用也较高。敏感性分析得出了类似的结果。
本研究结果突出了英格兰各地医院就诊的自伤发生率、医院费用和分布情况，并确定了可能受益于有针对性行动以帮助预防自伤和帮助自伤者的潜在亚人群。它们可以为国家和地方卫生利益相关者提供支持，以便在最需要预防和管理自伤的地区分配资金和确定干预措施的优先次序。
