Abstract
This is the first cost-effectiveness analysis of a brief therapy, the Attempted Suicide Short Intervention Program (ASSIP), for individuals who attempt suicide. To explore the cost-effectiveness of the ASSIP intervention in the context of the Swiss health care system. In this economic evaluation, the cost-effectiveness analysis was performed from a health care perspective between January 2017 and April 2018 using data from a randomized clinical trial conducted between June 2009 and December 2014. Participants were individuals who had attempted suicide and were receiving treatment at a psychiatric university hospital in Switzerland that provides inpatient and outpatient services for suicide attempters referred from an emergency department of a general hospital. The intervention group received 3 manual-based therapy sessions followed by regular personalized letters over 24 months. The control group was offered a single suicide risk assessment. The main economic analysis explored cost per suicide attempt avoided expressed in 2015 Swiss francs (CHF). Cost-effectiveness planes were plotted and cost-effectiveness acceptability curves calculated. One hundred twenty participants (mean [SD] age, 37.8 [14.4] years; 66 [55%] women and 54 [45%] men) were assigned to an intervention group or a control group, each with 60 participants. At 24 months of follow-up, 5 suicide attempts were reported in the ASSIP group among 59 participants with follow-up data available, and 41 were reported in the control group among 53 participants with follow-up data available. The ASSIP group had higher intervention costs, with CHF 1323 vs CHF 441 for the control group. At 24 months of follow-up, psychiatric hospital costs were lower in the ASSIP group than in the control group, although this difference was not significant (mean [SD], CHF 20 559 [38 676] vs CHF 45 488 [73 306]; mean difference, CHF -16 081; 95% CI, CHF -34 717 to 1536; P = .11). General hospital costs were significantly lower for the ASSIP group. Total health care costs were also lower, but the difference was not significant (mean [SD], CHF 21 302 [38 819] vs 41 287 [74 310]; difference, CHF -12 604; 95% CI, CHF -29 837 to 625; P = .14). In a base-case analysis, ASSIP was dominant, with significantly fewer reattempts at lower overall cost. The intervention had a 96% chance of being less costly and more effective. A sensitivity analysis showed a 96% and 95% chance of ASSIP being more effective and less costly at willingness-to-pay levels of CHF 0 and CHF 30 000, respectively. The ASSIP intervention is a cost-saving treatment for individuals who attempt suicide. The findings support the use of ASSIP as a treatment for suicide attempters. Further studies are needed to determine cost-effectiveness in other contexts. ClinicalTrials.gov Identifier: NCT02505373.
Highlights
According to World Health Organization statistics, more than 800 000 people die of suicide every year, and 10 to 20 times more people attempt suicide.[1]
At 24 months of follow-up, 5 suicide attempts were reported in the Attempted Suicide Short Intervention Program (ASSIP) group among 59 participants with follow-up data available, and 41 were reported in the control group among 53 participants with follow-up data available
The findings support the use of ASSIP as a treatment for suicide attempters
Summary
According to World Health Organization statistics, more than 800 000 people die of suicide every year, and 10 to 20 times more people attempt suicide.[1]. The economic costs associated with health and social care services due to suicidal behaviors, such as medical emergency treatment, general and psychiatric hospitalizations, outpatient care, informal care costs, and productivity losses, are enormous. In the United States, the yearly costs of suicidal behavior, which includes suicide and attempted suicide, have been estimated at $93.5 billion.[6] In Scotland, the costs of all suicides per year have been reported to be over £1 billion.[7] For attempted suicide, the mean costs at a hospital in Oxford in the United Kingdom, including psychosocial assessment and general hospital services, were estimated to be £809 per patient. In Switzerland, the total medical and psychiatric treatment costs of suicide attempts for a population of 8 million people were estimated at CHF 191 million per year.[9]
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