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Modeling the Cost-Effectiveness of Interventions to Reduce Suicide Risk Among Hospital Emergency Department Patients.
- Source :
-
Psychiatric services (Washington, D.C.) [Psychiatr Serv] 2018 Jan 01; Vol. 69 (1), pp. 23-31. Date of Electronic Publication: 2017 Sep 15. - Publication Year :
- 2018
-
Abstract
- Objective: This study estimated the expected cost-effectiveness and population impact of outpatient interventions to reduce suicide risk among patients presenting to general hospital emergency departments (EDs), compared with usual care. Several such interventions have been found efficacious, but none is yet widespread, and the cost-effectiveness of population-based implementation is unknown.<br />Methods: Modeled cost-effectiveness analysis compared three ED-initiated suicide prevention interventions previously found to be efficacious-follow-up via postcards or caring letters, follow-up via telephone outreach, and suicide-focused cognitive-behavioral therapy (CBT)-with usual care. Primary outcomes were treatment costs, suicides, and life-years saved, evaluated over the year after the index ED visit.<br />Results: Compared with usual care, adding postcards improved outcomes and reduced costs. Adding telephone outreach and suicide-focused CBT, respectively, improved outcomes at a mean incremental cost of $4,300 and $18,800 per life-year saved, respectively. Monte Carlo simulation (1,000 repetitions) revealed the chance of incremental cost-effectiveness to be a certainty for all three interventions, assuming societal willingness to pay ≥$50,000 per life-year. These main findings were robust to various sensitivity analyses, including conservative assumptions about effect size and incremental costs. Population impact was limited by low sensitivity of detecting ED patients' suicide risk, and health care delivery inefficiencies.<br />Conclusions: The highly favorable cost-effectiveness found for each outpatient intervention provides a strong basis for widespread implementation of any or all of the interventions. The estimated population benefits of doing so would be enhanced by increasing the sensitivity of suicide risk detection among individuals presenting to general hospital EDs.
- Subjects :
- Adult
Humans
Models, Statistical
Outpatients statistics & numerical data
Postcards as Topic statistics & numerical data
Telephone statistics & numerical data
Aftercare economics
Aftercare methods
Aftercare statistics & numerical data
Cognitive Behavioral Therapy economics
Cognitive Behavioral Therapy methods
Cognitive Behavioral Therapy statistics & numerical data
Cost-Benefit Analysis statistics & numerical data
Emergency Service, Hospital economics
Emergency Service, Hospital statistics & numerical data
Outcome and Process Assessment, Health Care economics
Outcome and Process Assessment, Health Care statistics & numerical data
Suicide economics
Suicide statistics & numerical data
Suicide Prevention
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9700
- Volume :
- 69
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Psychiatric services (Washington, D.C.)
- Publication Type :
- Academic Journal
- Accession number :
- 28945181
- Full Text :
- https://doi.org/10.1176/appi.ps.201600351