Le Long Khanh-Dao, Flego Anna, Krysinska Karolina, Andriessen Karl, Bandara Piumee, Page Andrew, Schlichthorst Marisa, Pirkis Jane, Mihalopoulos Cathrine, Carter Greg, Reifels Lennart
Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
BJPsych Open. 2023 Aug 1;9(5):e139. doi: 10.1192/bjo.2023.525.
Prior self-harm represents the most significant risk factor for future self-harm or suicide.
To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context.
We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted.
The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses.
A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.
既往的自我伤害是未来自我伤害或自杀的最重要风险因素。
评估在澳大利亚背景下，针对医院治疗的自我伤害事件进行的一种理论性简短后续护理干预措施（包括简短随访联系、护理协调和安全规划）在减少重复自我伤害方面的成本效益。
我们采用经济建模技术进行：（a）投资回报率分析，将干预措施产生的成本节约与实施干预措施的总成本进行比较；（b）成本效用分析，将干预措施的净成本与以质量调整生命年（QALYs）衡量的健康结果进行比较。在基础案例分析中，我们考虑了与自我伤害住院相关的成本抵消以及10年内的自杀成本。还进行了不确定性和单向敏感性分析。
简短后续护理干预措施带来了750万澳元的净成本节约（95%不确定性区间：-5620万澳元至1510万澳元），并在10年内带来了222个QALYs的收益（95%不确定性区间：45至563）。干预措施模拟成本与成本节约相关的估计投资回报率为1.58（95%不确定性区间：-0.17至5.33）。87%的不确定性迭代表明，该干预措施可被视为具有成本效益，要么通过成本节约，要么以每获得一个QALY 50000澳元的可接受成本效益比来衡量。在敏感性分析中，结果仍然稳健。
一种理论性简短后续护理干预措施极有可能在预防有自我伤害史的个体自杀和自我伤害方面具有成本效益。
