Cost-Effectiveness of a Rapid Response Team Intervention for Suicidal Youth Presenting at an Emergency Department

Abstract

Objective: To investigate the cost-effectiveness of a rapid response team (RRT), compared with usual care (UC), for treating suicidal adolescents. Methods:Suicidal adolescents (n = 286) presenting at an emergency department were enrolled in a trial to compare UC with enhanced outpatient care provided by an RRT of health professionals. Functioning (Child Global Assessment Scale) and suicidality (Spectrum of Suicidal Behavior Scale) scores were measured at baseline and 6 months later. Resource use and cost data were collected from several sources during the same period.Results: As previously reported, there was no statistically or clinically significant difference in either functioning or suicidality between the groups. Costs of the RRT were lower by $1886, thus -$1886 (95% CI -$4238 to $466), from the perspective of the treating hospital, and by $991, thus -$991 (95% CI -$5580 to $3598), from the perspective of society. If decision makers are not willing to pay for any improvement in functioning or suicidality, the RRT has a 95% probability of being cost-effective from the perspective of the treating hospital. From the point of view of society, the probability of the intervention being cost-effective is about 70% for functioning and 63% for suicidality. The difference between the 2 perspectives is mainly attributable to the cost of hospitalizations outside the treating hospital. Conclusions:An RRT intervention appears to be cost-effective, compared with UC, from the point of view of the treating hospital, but there is no difference from the point of view of society. W W W Rentabilité d'une équipe d'intervention rapide pour les adolescents suicidaires qui se présentent au service d'urgenceObjectif : Étudier la rentabilité d'une équipe d'intervention rapide (EIR), comparativement aux soins usuels (SU), pour traiter des adolescents suicidaires. Méthodes :Des adolescents suicidaires (n = 286) qui se sont présentés à un service d'urgence ont été inscrits dans un essai pour comparer les SU avec des soins ambulatoires améliorés fournis par une EIR de professionnels de la santé. Les scores de fonctionnement (échelle d'évaluation globale pour enfants) et de suicidabilité (échelle du spectre du comportement suicidaire) ont été mesurés au départ et au suivi de 6 mois. Les données sur l'utilisation des ressources et les coûts ont été recueillies auprès de plusieurs sources durant la même période.Résultats : Comme il a été précédemment constaté, il n'y avait pas de différence statistiquement ou cliniquement significative de fonctionnement ou de suicidabilité entre les groupes. Les coûts de l'EIR étaient inférieurs de 1886 $, donc −1886 $ (IC à 95 % −4238 $ à 466 $), du point de vue de l'hôpital traitant, et de 991 $, donc −991 $ (IC à 95 % −5580 $ à 3598 $), du point de vue de la société. Si les décideurs ne sont pas disposés à payer pour toute amélioration du fonctionnement ou de la suicidabilité, l'EIR a une probabilité de 95 % d'être rentable du point de vue de l'hôpital traitant. Du point de vue de la société, la probabil...

Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system

“…Timely assessment strategies, including screening, were att ributes of interventions for a range of mental health problems examined in 10 of the included studies (Box 4). 47,[49][50][51][52][53][54][55][56][57] The economic evidence for such approaches was generally favourable, although there were exceptions. 52,55 Schools-based screening and prevention interventions were examined for anxiety, 58 depression, 47,53,62,63 eating disorders 52,59 and substance use disorders.…”

“…66,68,69 A group delivery context (including in classrooms) was an att ribute of interventions for a range of mental health problems in nine studies, 47,52,58,[60][61][62][63]70,71 again with cost-eff ectiveness evidence that varied between populations. Other att ributes of interventions examined were automated processes, 63 case management, 48,50,65-67 crisis response, 51 fi nancing, 72 holistic care approaches, 48,58,72 information provision, 54,57,61,62,67,69,71 peer support and mentoring 57,71 and staff training and support 49 (Box 4).…”

Child and Adolescent Emergency Psychiatry: A Review of Recent Developments

“…As noted before, many regions rely on general emergency or pediatric emergency departments for such care. One study found that a rapid response team of behavioral experts who supported a pediatric emergency department was both clinically effective and was able to provide substantial cost savings to the institution [46]. Urgent psychiatric consults to medical and pediatric EDs are another recently studied option and have had similar positive results [47].…”

Open Trial and Pilot Randomized Controlled Trial of a Novel Program to Reduce Perceived Burdensomeness

“…Additional interventions include the use of rapidresponse teams to link suicidal emergency department patients to outpatient services (Greenfield, Lawson, Hechtman, Rousseau, & Platt, 2002;Latimer, Gariepy, & Greenfield, 2014), dialectical behavior therapy (Katz, Cox, Gunasekara, & Miller 2004;Rathus & Miller, 2002), multisystemic therapy (Huey et al, 2004), skills-based treatment (Donadlson, Spirito, & Esposito-Smythers, 2005), individual cognitive-behavioral therapy (Esposito-Smythers, Spirito, Kahler, Hunt, & Monti, 2011), and crisis hotlines for urgent counseling (Gould, Cross, Pisani, Munfakh, & Kleinman, 2013).…”

“…The rapid response model was more cost-effective as a method for linking suicidal adolescents to outpatient care as compared to usual care practices, as a result of the reduced rate of hospitalizations (Latimer, Gariepy, & Greenfield, 2014).…”