BACKGROUND Self-harm is a major health issue resulting in high societal costs. Few psychological and psychosocial interventions have shown effectiveness in reducing repeat self-harm. OBJECTIVE To assess the cost-effectiveness of psychological and psychosocial interventions that have shown evidence of effectiveness in adults and CYP (children and young people) who have self-harmed. METHODS Using effectiveness data from Cochrane reviews, we developed two decision-analytical models to compare costs and quality-adjusted life years (QALYs) of cognitive behavioural therapy (CBT)-informed psychological therapy added to treatment as usual (TAU) versus TAU alone for adults who have self-harmed, and of dialectical behavioural therapy for adolescents (DBT-A) versus enhanced TAU for CYP who have self-harmed, respectively, from a National Health Service and personal social services perspective in England. Other model input parameters were obtained from published sources, supplemented by expert opinion. FINDINGS The incremental cost-effectiveness ratio (ICER) of CBT-informed psychological therapy added to TAU versus TAU alone for adults who have self-harmed was £9088/QALY. The ICER of DBT-A versus enhanced TAU for CYP who have self-harmed was £268 601/QALY. Results were overall robust to the alternative scenarios tested. CONCLUSIONS AND CLINICAL IMPLICATIONS CBT-informed psychological therapy appears to be cost-effective for adults who have self-harmed, which contributes to evidence for its implementation in services. Currently, DBT-A does not seem to be cost-effective for CYP who have self-harmed. The economic analyses were informed by clinical evidence of moderate-to-low (CBT) and low (DBT-A) quality. Further clinical and economic evidence for DBT-A and other psychological and psychosocial interventions for people who have self-harmed is required.

中文翻译：

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对自我伤害的成人、儿童和年轻人的心理和社会心理干预的成本效益。


背景 自残是一个主要的健康问题，导致高昂的社会成本。很少有心理和社会心理干预显示出减少重复自我伤害的有效性。目的 评估心理和社会心理干预的成本效益，这些干预已显示出对自残成人和 CYP（儿童和青少年）的有效性证据。方法 使用来自 Cochrane 系统综述的有效性数据，我们开发了两个决策分析模型，以比较认知行为疗法 （CBT） 知情心理疗法与单独 TAU 在常规治疗 （TAU） 中加入自我伤害的成年人的成本和质量调整生命年 （QALYs），以及青少年辩证行为疗法 （DBT-A） 与增强 TAU 治疗自残 CYP 的成本和质量调整生命年 （QALYs）， 分别从英格兰的国民健康服务和个人社会服务的角度来看。其他模型输入参数来自已发表的来源，并辅以专家意见。结果对于自残的成年人，CBT 知情心理治疗加入 TAU 与单独使用 TAU 的增量成本效益比 （ICER） 为 £9088/QALY。对于自残的 CYP，DBT-A 与增强 TAU 的 ICER 为 268 601 英镑/QALY。结果总体上对所测试的替代情景是稳健的。结论和临床意义 CBT 知情心理治疗对于自残的成年人似乎具有成本效益，这有助于为其在服务中实施提供证据。目前，DBT-A 对于自残的 CYP 来说似乎并不划算。经济分析以中低 （CBT） 和低 （DBT-A） 质量的临床证据为依据。 需要进一步的临床和经济证据来证明 DBT-A 和其他针对自残者的心理和社会心理干预。