Costs, benefits, and cost-benefit of Collaborative Assessment and Management of Suicidality versus enhanced treatment as usual

Abstract

Suicide rates have been steadily increasing in both the U.S. general population and military, with significant psychological and economic consequences. The purpose of the current study was to examine the economic costs and cost-benefit of the suicide-focused Collaborative Assessment and Management of Suicidality (CAMS) intervention versus enhanced treatment as usual (ETAU) in an active duty military sample using data from a recent randomized controlled trial of CAMS versus ETAU. The full intent-to-treat sample included 148 participants (mean age 26.8 years ± 5.9 SD years, 80% male, 53% White). Using a micro-costing approach, the cost of each condition was calculated at the individual level from a healthcare system perspective. Benefits were estimated at the individual level as cost savings in past-year healthcare expenditures based on direct care reimbursement rates. Cost-benefit was examined in the form of cost-benefit ratios and net benefit. Total costs, benefits, cost-benefit ratios, and net benefit were calculated and analyzed using general linear mixed modeling on multiply imputed datasets. Results indicated that treatment costs did not differ significantly between conditions; however, CAMS was found to produce significantly greater benefit in the form of decreased healthcare expenditures at 6-month follow-up. CAMS also demonstrated significantly greater cost-benefit ratios (i.e., benefit per dollar spent on treatment) and net-benefit (i.e., total benefit less the cost of treatment) at 12-month follow-up. The current study suggests that beyond its clinical effectiveness, CAMS may also convey potential economic advantages over usual care for the treatment of suicidal active duty service members. Our findings demonstrate cost savings in the form of reduced healthcare expenditures, which theoretically represent resources that can be reallocated toward other healthcare system needs, and thus lend support toward the overall value of CAMS.

Evidence-based care for suicidality as an ethical and professional imperative: How to decrease suicidal suffering and save lives.

“…As described by Swift et al (2021) across clinical trials, CAMS reduces suicidal ideation, overall symptom distress, and hopelessness (while increasing hope), and there are promising data that it also reduces suicidal behaviors (e.g., Santel et al, 2023). CAMS is cost-effective (McCutchan et al, 2022), fairly easy to learn, helps decrease malpractice liability, and can be used flexibly across a range of clinical settings and populations (Jobes et al, 2018).…”

Zero Suicide – What About “Treat”?

“…CAMS reliably reduces suicidal ideation, symptom distress, and hopelessness (while increasing hope) in comparison with control care (Swift et al, 2021). CAMS can significantly reduce suicide attempts (Santel et al, 2023), is cost-effective (McCutchan et al, 2022), and telehealth-CAMS is effective (O'Neill et al, 2023).…”

Cost-inclusive research on health psychology interventions: Why, how, and what next.

“…This can be calculated for each individual patient and analyzed statistically like any other variable. For instance, in an RCT for suicidal patients, McCutchan et al (2022) found that Enhanced Treatment As Usual (ETAU) cost significantly more than the cost-savings it produced, but that Collaborative Assessment and Management of Suicidality (CAMS) did not cost significantly more than the cost-savings it produced, according to nonparametric analyses of patient-level net benefit. Funder interest in whether an HPI “paid for itself” for an individual or a group has been tested by comparing mean or median net benefit against a hypothetical net benefit of zero (for which benefits equal costs; Gorman, 2012; Ryan, 2015).…”