A cost-effectiveness analysis of school-based suicide prevention programmes

Abstract

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer's perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.Trial registration number DRKS00000214.

The Role of the School Nurse in Suicide Interventions: An Integrative Review

“…Improving caseloads and accessibility of SNs should be considered as research has found identification of at-risk for suicide adolescents is positively correlated with time spent with those trained in identifying at-risk students (Condron et al, 2015). Research has also shown that school-based suicide prevention programs are cost-effective when compared to the estimated cost of over US$1 million for one suicide (Ahern et al, 2018). Investing in SNs for prevention and intervention of suicide is worthwhile to students, schools, families, and communities.…”

Economic Evaluations of Public Health Interventions to Improve Mental Health and Prevent Suicidal Thoughts and Behaviours: A Systematic Literature Review

“…In general, most of the interventions were provided in collaboration between different societal sectors, such as health care, elderly care, educational sector and labor market. Of the two suicide prevention evaluations, one study (Ahern et al 2018) analyzed three different universal interventions at school, for school pupils, one of which was cost-effective. The second study (Comans et al 2013) evaluated an indicated intervention given to people bereaved by suicide, and was cost-effective.…”

“…Results of the nine studies (around 50% of included articles) were considered to have high potential of transferability to the Swedish context (Ahern et al 2018;Anderson et al 2014;Bosmans et al 2014;Buntrock et al 2017;Lewis et al 2017;Philipsson et al 2013;Uegaki et al 2011;van den Berg et al 2011;van Oostrom et al 2010). Only two studies evaluated interventions delivered to Swedish populations (Philipsson et al 2013;Ahern et al 2018). The first evaluated a dance intervention for teenage girls with mental health problems and was cost-effective from a societal perspective.…”

“…The first evaluated a dance intervention for teenage girls with mental health problems and was cost-effective from a societal perspective. The second study (Ahern et al 2018) evaluated three suicide preventive interventions, where only one was cost-effective according to the Swedish willingness-to-pay threshold.…”

Net benefit separation and the determination curve: A probabilistic framework for cost-effectiveness estimation

“…Delaney et al, for instance, utilize a CEA as evidence in support of initial endoscopy in dyspepsia patients, 16 and mental health studies have commonly included CEAs for decision-making purposes in various interventions, sometimes under the name "probabilistic sensitivity analysis". 17,18 However, Barton et al note that the CEA, despite its widespread use, does not alone provide a path for optimal decision-making as it does not provide insights into the extent of cost-effectiveness. 19 Some have proposed alternative graphical tools to the CEA in response to the challenges associated with interpreting it as a probability of cost-effectiveness within the frequentist paradigm.…”