JMIR Publications

ABSTRACT

Background:

Nonsuicidal self-injury (NSSI) is common among adolescents and is associated with adverse clinical outcomes as well suicidal behaviour. Current treatments are resource-intensive and may not be accessible to all adolescents with NSSI. Internet-delivered emotion regulation individual therapy for adolescents (IERITA) with nonsuicidal self-injury disorder is a promising treatment option, but its cost-effectiveness is unknown.

Objective:

To evaluate the cost-effectiveness of IERITA for adolescents with nonsuicidal self-injury disorder.

Methods:

Within-trial cost-effectiveness analysis of a randomized controlled trial at three child and adolescent mental health services in Sweden (n = 166). Twelve weeks of IERITA plus treatment as usual (TAU) versus TAU only were compared. The primary outcome was frequency of nonsuicidal self-injury (NSSI) at 1-month post-treatment. Secondary outcomes were NSSI remission and quality-adjusted life-years (QALYs).

Results:

IERITA led to reductions in NSSI frequency, a higher proportion of participants with NSSI remission, and more QALYs at 1-month post-treatment, at additional healthcare costs of $3663 (95% CI $2182 to $5002) and societal costs of $4458 ($-577 to $9509). The incremental cost of one additional NSSI remission at 1-month post-treatment was $18,677, and the incremental cost per QALY gained was $792,244 for IERITA+TAU relative to TAU. IERITA had a 8% probability of being cost-effective at a societal willingness to-pay threshold of $84,000 for one QALY at 1-month post-treatment, which increased to 18% at 3-months post-treatment.

Conclusions:

IERITA delivered adjunctive to TAU led to improvements in NSSI frequency, remission, and QALYs, at additional costs compared to TAU only. This study provides an estimate of the additional cost of delivering IERITA, however, future studies should include longer follow-up periods to better assess the magnitude of the effects on QALYs and societal costs.