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.
Highlights
Amid unprecedented increases in active duty military suicide rates in recent years, the U.S Department of Defense (DoD) has recognized suicide prevention to be a top military priority [1,2]
Of the 148 individuals enrolled in the study, 73 were randomized to the Collaborative Assessment and Management of Suicidality (CAMS) condition and 75 were randomized to enhanced treatment as usual (ETAU)
ETAU eventually matched CAMS in total cumulative healthcare expenditures at 12-month follow-up timepoints, crisis services expenditures remained significantly lower for CAMS
Summary
Active duty service members have demonstrated continuously rising suicide rates across all branches of service. In 2019, the suicide mortality rate for the Active Component (i.e., fulltime service members) across all services was 25.9 per 100,000, representing a per-year rate ratio of 1.04 from calendar years 2011 through 2019 [3]. These trends are alarming in that they represent the first time in recorded history that the U.S military suicide rate has equaled or exceeded that of comparable U.S general population cohorts, beginning in 2008 and continuing to date. The exact causes of the increase in military suicides are uncertain, the most consistently reported factor appears to be increasing co-occurrence of mental health conditions such as posttraumatic stress disorder (PTSD), depression, and substance use [5,6,7,8,9]
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