Cost-effectiveness of a brief structured intervention program aimed at preventing repeat suicide attempts among those who previously attempted suicide. A secondary analysis of the ASSIP randomized clinical trial

Park, A-La; Gysin-Maillart, Anja Carolyn; Müller, Thomas; Exadaktylos, Aristomenis; Michel, Konrad (2018). Cost-effectiveness of a brief structured intervention program aimed at preventing repeat suicide attempts among those who previously attempted suicide. A secondary analysis of the ASSIP randomized clinical trial. Jama Network Open, 1(6), e183680. American Medical Association 10.1001/jamanetworkopen.2018.3680

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IMPORTANCE This is the first cost-effectiveness analysis of a brief therapy, the Attempted Suicide Short Intervention Program (ASSIP), for individuals who attempt suicide. OBJECTIVE To explore the cost-effectiveness of the ASSIP intervention in the context of the Swiss health care system. DESIGN, SETTING, AND PARTICIPANTS 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. INTERVENTIONS 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. MAIN OUTCOMES AND MEASURES The main economic analysis explored cost per suicide attempt avoided expressed in 2015 Swiss francs (CHF). Cost-effectiveness planes were plotted and costeffectiveness acceptability curves calculated. RESULTS 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 differencewas 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 basecase 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. CONCLUSIONS AND RELEVANCE 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy > Translational Research Center
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy

UniBE Contributor:

Gysin-Maillart, Anja Carolyn; Müller, Thomas; Exadaktylos, Aristomenis and Michel, Konrad

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2574-3805

Publisher:

American Medical Association

Language:

English

Submitter:

Anja Carolyn Gysin-Maillart

Date Deposited:

04 Feb 2019 15:43

Last Modified:

23 Oct 2019 13:55

Publisher DOI:

10.1001/jamanetworkopen.2018.3680

PubMed ID:

30646253

BORIS DOI:

10.7892/boris.123084

URI:

https://boris.unibe.ch/id/eprint/123084

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