Krysinska Karolina, Andriessen Karl, Bandara Piumee, Reifels Lennart, Flego Anna, Page Andrew, Schlichthorst Marisa, Pirkis Jane, Mihalopoulos Cathrine, Khanh-Dao Le Long
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.
Translational Health Research Institute, Western Sydney University, NSW, Australia.
Crisis. 2024 Mar;45(2):118-127. doi: 10.1027/0227-5910/a000926. Epub 2023 Oct 31.
Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.
成人自我伤害后的心理社会干预措施，尤其是认知行为疗法（CBT），在降低反复自我伤害风险方面可能是有效的。为了评估在澳大利亚背景下CBT减少反复自我伤害的成本效益。本研究采用了使用投资回报率（ROI）分析的获取成本效益（ACE）方法。不确定性和敏感性分析（Sas）测试了模型输出对三个假设变化的稳健性：全科医生转诊途径（SA1）、私人环境干预实施（SA2）和培训成本（SA3）。根据干预效果持续2年或1年随访的情况，该干预措施节省了4600万澳元（95%可信区间-223.7至73.3）和1830万澳元（95%可信区间-86.2至24.6）。在SA1中，投资回报率降至5.22（95%可信区间-10.1至27.9），在SA2中为2.5（95%可信区间-4.8至13.3），在SA3中为5.1（95%可信区间-9.8至27.8）。我们假设在基础案例中，有效性将在5年内降低50%，并且我们使用了澳大利亚的数据和部分社会视角。本研究证明了CBT对于有自我伤害行为的成年人具有成本效益，每投资1澳元的投资回报率为2.3至6.0澳元。
