TY  - JOUR
PY  - 2021//
TI  - Cost-effectiveness of a culturally adapted manual-assisted brief psychological intervention for self-harm in Pakistan: a secondary analysis of the Culturally Adapted Manual-Assisted Brief Psychological Randomized Controlled Trial
JO  - Value in health regional issues
A1  - Alvi, Mohsin H.
A1  - Shiri, Tinevimbo
A1  - Iqbal, Nasir
A1  - Husain, Mohammed Omair
A1  - Chaudhry, Imran
A1  - Shakoor, Suleman
A1  - Ansari, Sami
A1  - Kiran, Tayyeba
A1  - Chaudhry, Nasim
A1  - Husain, Nusrat
SP  - 65
EP  - 71
VL  - 27
IS  - 
N2  - OBJECTIVES: Self-harm is a serious public health problem. A culturally adapted manual-assisted problem-solving training (C-MAP) intervention improved and sustained a reduction in suicidal ideation, hopelessness, and depression compared with treatment as usual (TAU) alone. Here, we evaluate its cost-effectiveness. <br><br>METHODS: Patients admitted after an episode of self-harm were randomized individually to either C-MAP plus TAU or TAU alone in Karachi. Improvement in health-related quality-adjusted life-years (QALYs) was measured using the EQ-5D with 3 levels instrument at baseline, 3 months, and 6 months after randomization. The primary economic outcome was health service cost per QALY gained as the incremental cost-effectiveness ratio, based on 2019 US$ and a 6-month time horizon. Nonparametric bootstrapping was used to assess uncertainties and sensitivity analysis to examine the impact of hospitalization costs. <br><br>RESULTS: A total of 108 and 113 participants were enrolled among the intervention and standard arms, respectively. The intervention resulted in 0.04 (95% confidence interval [CI] 0.00-0.08) more QALYs 6 months after enrolment. The mean cost per participant in the intervention arm was $1001 (95% CI 968-1031), resulting in an incremental cost of the intervention of $640 (95% CI 595-679). The incremental cost-effectiveness ratio for the C-MAP intervention versus TAU was $16 254 (95% CI 7116-99 057) per QALY gained. The probability that C-MAP is cost-effective was between 66% and 83% for cost-effective thresholds between $20 000 and $30 000. Cost-effectiveness results remained robust to sensitivity analyses. <br><br>CONCLUSIONS: C-MAP may be a valuable self-harm intervention. Further studies with longer follow-up and larger sample sizes are needed to draw reliable conclusions.<p />  <p>Language: en</p>
LA  - en
SN  - 2212-1099
UR  - http://dx.doi.org/10.1016/j.vhri.2021.08.005
ID  - ref1
ER  -