Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis Short title: Cost-effectiveness of psychosocial assessment
McDaid D., Park AL., Tsiachristas A., Brand F., Casey D., Clements C., Geulayov G., Kapur N., Ness J., Waters K., Hawton K.
Background Guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence is variable. There is some evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm, but the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm is unknown. Methods. A three-state four-cycle Markov model was used to assess cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over two years. Data on risk of subsequent self-harm and hospital costs of treating self-harm were drawn from the Multicentre Study of Self-Harm in England, while estimates of effectiveness of psychosocial assessment on risk of self-harm, quality of life and other costs were drawn from literature. Incremental cost-effectiveness ratios (ICERs) for cost per Quality Adjusted Life Year (QALY) gained were estimated. Parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses. Results. Cost per QALY gained from psychosocial assessment was £10, 962 (95% uncertainty interval (UI) £15, 538 - £9, 219) from the NHS perspective, and £9, 980 (95% UI £14, 538 - £6, 938) from the societal perspective. Results were generally robust to changes in model assumptions. The probability of the ICER being below £20, 000 per QALY gained was 78%, rising to 91% with a £30, 000 threshold. Conclusions Psychosocial assessment as implemented in the English NHS is likely to be cost51 effective. This evidence could support adherence to NICE guidelines. However, further evidence is needed about the precise impacts of psychosocial assessment on self-harm repetition and costs to individuals and their families beyond immediate hospital stay.