Cost Effectiveness of Sertraline for Preventing Domestic Violence Reoffending Among Highly Impulsive Violent Offenders in Australia: A Trial-Based Economic Evaluation.

backgroundDomestic violence generates significant health and justice costs, yet there is little trial-based clinical or economic evidence on pharmacological interventions for high-risk offenders. We evaluated the cost effectiveness of sertraline for reducing domestic violence reoffending among men with serious violent offending histories and high impulsivity.

objectiveThe primary objective was to estimate the incremental cost per domestic violence reoffence prevented for sertraline compared with placebo from a government payer perspective over 24 months.

methodsWe conducted a cost-effectiveness analysis alongside a 24-month, double-blind, randomised controlled trial in New South Wales, Australia, comparing sertraline (n = 319) with placebo (n = 311). Both randomised groups received identical clinical support. A prespecified non-randomised group (N-Rand; n = 166) included eligible men who did not proceed to randomisation. The primary economic outcome was incremental cost per domestic violence reoffence prevented from a government perspective. Uncertainty was characterised using a probabilistic sensitivity analysis.

resultsDomestic violence reoffending was lower with sertraline than placebo (28.2% vs 35.9%; risk ratio 0.79, p = 0.039) and N-Rand (42.2%; risk ratio 0.67, p = 0.002). Relative to placebo, sertraline generated net savings of Australian dollars (A$) 4443 per participant (A$57,636 per domestic violence reoffence prevented), with criminal justice savings (A$4839) exceeding medication costs (A$396). Relative to N-Rand, net savings were A$3327 per participant (A$23,841 per domestic violence reoffence prevented). In priobabilistic sensitivity analysis, sertraline (compared to placebo) had a mean incremental cost of -A$4507 (95% uncertainty interval -A$9,433, A$249) and 0.077 domestic violence reoffences prevented (95% confidence interval 0.004, 0.149). Sertraline was dominant in 95.1% of simulations, and in 84.9% versus N-Rand.

conclusionsAllocation to sertraline was associated with lower government costs and fewer domestic violence reoffences than placebo among men with serious violent offending histories and high impulsivity. Each reoffence prevented represents a reduction in violence experienced by victims, partners and children. These findings support consideration of sertraline as an adjunct within intervention and diversion programmes for high-risk offenders, where clinically indicated. CLINICAL

trial registrationAustralian New Zealand Clinical Trials Registry Identifier: ACTRN12613000442707.