New analysis finds a strong economic case for providing a psychosocial assessment to all people admitted to hospital for self-harm.
Self-harm is a major problem worldwide, with profound impacts on individuals and healthcare services alike. Previous research led by Oxford Population Health found that in England alone more than 200,000 people attend hospital because of self-harm each year, at a cost of over £128 million.
According to national clinical guidelines, all those who are admitted to hospital for self-harm should be given a psychosocial assessment, so that they can receive appropriate aftercare in the community. This is particularly important given that these people are 50 times more likely to commit suicide than the general population, with this risk being especially high in the months following hospital discharge. However, provision of these assessments varies considerably across hospitals in England, being only 50-60% on average.
Potentially, evidence that psychosocial assessments are a cost-effective public health intervention could encourage greater adherence to these guidelines. To investigate this, a new study led by the Health Economics Research Centre (HERC) at Oxford Population Health and the London School of Economics and Political Science assessed the cost-effectiveness of psychosocial assessment after self-harm compared with no assessment. The results have been published in European Psychiatry.
The research team used data from a range of sources including the Multicentre Study of Self-Harm in England to generate an economic model of self-harm in England. This included data on the risk of subsequent self-harm following hospital admission, hospital costs of treating self-harm, and estimates of the effectiveness of psychosocial assessments in preventing future episodes of self-harm or suicide.
The model estimated the costs to the NHS of providing psychosocial assessments for each Quality Adjusted Life Year (QALY)* gained. In England, interventions that have a cost per QALY of £20,000 or under are considered cost-effective.
- Providing psychosocial assessments to all people who presented at hospital for self-harm would be a highly cost-effective measure, with a cost per QALY of £10,962.
- When additional societal costs were included (such as lost productivity during inpatient admission), the cost per QALY fell to £9,980.
- The researchers tested how robust the cost-effectiveness of psychosocial assessments were to fluctuations in the underlying parameters, such as hospital costs and the effectiveness of the assessments in preventing readmission. Based on 10,000 different simulations of the model, there was a 78% overall likelihood that the psychosocial assessments would be cost-effective, with a cost per QALY gained below £20,000.
- Even if the risk of repeated self-harm following psychosocial assessment rose by 20%, the intervention would still be cost-effective at £18,344 per QALY gained.
According to the researchers, the cost-effectiveness of psychosocial assessments may be even greater, since the model did not include wider societal impacts, such as the benefits for families of reduced episodes of self-harm/suicide, and productivity losses associated with suicide. However, there is a need for further research into how the effectiveness of psychosocial assessments is affected by factors such as patient history, socio-economic deprivation, and health inequalities.
One of the lead authors, Associate Professor Apostolos Tsiachristas said: ‘We believe this is the first economic evaluation of providing psychosocial assessment for all people admitted to hospital due to self-harm. Based on this evidence, we hope that hospitals will comply with NICE guidelines to provide psychosocial assessment to all these patients.’
*Quality Adjusted Life Years (QALYs) are a standard metric used to compare the cost-effectiveness of different healthcare interventions. One QALY is equivalent to an additional year gained at full health.