Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide : cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial
(2024) In Nordic Journal of Psychiatry- Abstract
Background: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest... (More)
Background: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. Conclusion: BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.
(Less)
- author
- Lindkvist, Rose Marie LU ; Steen Carlsson, Katarina LU ; Daukantaitė, Daiva LU ; Flyckt, Lena and Westling, Sofie LU
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- in press
- subject
- keywords
- cost effectiveness, crisis intervention, Randomized controlled trial, self-injurious behavior, suicide prevention
- in
- Nordic Journal of Psychiatry
- publisher
- Informa Healthcare
- external identifiers
-
- pmid:38875018
- scopus:85196071230
- ISSN
- 0803-9488
- DOI
- 10.1080/08039488.2024.2366854
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
- id
- 4d946d19-b8ac-4331-9471-4a28af6898cc
- date added to LUP
- 2024-07-25 15:38:01
- date last changed
- 2024-08-22 18:09:18
@article{4d946d19-b8ac-4331-9471-4a28af6898cc, abstract = {{<p>Background: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. Conclusion: BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.</p>}}, author = {{Lindkvist, Rose Marie and Steen Carlsson, Katarina and Daukantaitė, Daiva and Flyckt, Lena and Westling, Sofie}}, issn = {{0803-9488}}, keywords = {{cost effectiveness; crisis intervention; Randomized controlled trial; self-injurious behavior; suicide prevention}}, language = {{eng}}, publisher = {{Informa Healthcare}}, series = {{Nordic Journal of Psychiatry}}, title = {{Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide : cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial}}, url = {{http://dx.doi.org/10.1080/08039488.2024.2366854}}, doi = {{10.1080/08039488.2024.2366854}}, year = {{2024}}, }