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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

Lindkvist, Rose Marie LU orcid ; Steen Carlsson, Katarina LU orcid ; Daukantaitė, Daiva LU ; Flyckt, Lena and Westling, Sofie LU orcid (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.

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Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
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 &gt;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}},
}