Presentation (CTI)

OBJECTIVES: Self-harm and suicide are public health priorities that necessitate effective and economically sustainable preventive strategies. Individual-level, service-level, and staff-training interventions have demonstrated effectiveness. We report a systematic review of economic evaluations of these interventions within healthcare settings.
METHODS: A comprehensive search was conducted in databases (Medline, Embase, Econlit, CINAHL, Web of Science and PsycINFO) for full economic evaluations of service-level, individual-level and staff-training interventions targeting self-harm and suicide prevention in healthcare settings (January 2003 - November 2023). Methodological and reporting quality were assessed using standard tools.
RESULTS: In total, 27 studies evaluating 27 individual-level, one staff-training, one service-level and four mixed interventions met the inclusion criteria. Over time, methods have moved from purely trial-based analyses (n=11) to include model-based analyses (n=16), of which 11 were Markov models. Both general and high-risk populations were examined. Outcomes ranged from cost per self-harm episode averted, cost per suicide averted to cost per extra quality-adjusted life-year (QALY). Sixteen studies included only healthcare sector costs. Study heterogeneity precluded meaningful direct comparison between studies. The results indicate a broad range (USD12,321-USD327,138 per QALY) of cost-effectiveness across different interventions. Study quality was generally good, with some limitations in model validity.
CONCLUSIONS: Most of the interventions studied demonstrated significant potential for cost savings and improved health outcomes. Variation in methods used underscores the need for standardized approaches in costing and outcome measurement. As the use of modelling expands in this area, further work is needed to develop more consensus in how to measure and model longer-term outcomes.