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Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada

Author

Listed:
  • Michael Lebenbaum

    (University of Toronto)

  • Joyce Cheng

    (University of Toronto
    Centre for Addiction and Mental Health (CAMH))

  • Claire Oliveira

    (University of Toronto
    Centre for Addiction and Mental Health (CAMH)
    ICES)

  • Paul Kurdyak

    (University of Toronto
    ICES
    Centre for Addiction and Mental Health)

  • Juveria Zaheer

    (Centre for Addiction and Mental Health (CAMH)
    University of Toronto)

  • Rebecca Hancock-Howard

    (University of Toronto)

  • Peter C. Coyte

    (University of Toronto)

Abstract

Background Although suicide-prevention campaigns have been implemented in numerous countries, Canada has yet to implement a strategy nationally. This is the first study to examine the cost utility of the implementation of a multidimensional suicide-prevention program that combines several interventions over a 50-year time horizon. Methods We used Markov modeling to capture the dynamic changes to health status and estimate the incremental cost per quality-adjusted life-year gained over a 50-year period for Ontario residents for a suicide-prevention strategy compared to no intervention. The strategy consisted of a package of interventions geared towards preventing suicide including a public health awareness campaign, increased identification of individuals at risk, increased training of primary-care physicians, and increased treatment post-suicide attempt. Four health states were captured by the Markov model: (1) alive and no recent suicide attempt; (2) suicide attempt; (3) death by suicide; (4) death (other than suicide). Analyses were from a societal perspective where all costs, irrespective of payer, were included. We used a probabilistic analysis to test the robustness of the model results to both variation and uncertainty in model parameters. Results Over the 50-year period, the suicide-prevention campaign had an incremental cost-effectiveness ratio (ICER) of $18,853 (values are in Canadian dollars) per QALY gained. In all one-way sensitivity analyses, the ICER remained under $50,000/QALY. In the probabilistic analysis, there was a probability of 94.8% that the campaign was cost effective at a willingness-to-pay of $50,000/QALY (95% confidence interval of ICER probabilistic distribution: 2650–62,375). Among the current population, the intervention was predicted to result in the prevention of 4454 suicides after 50 years (1033 by year 10; 2803 by year 25). A healthcare payer perspective sensitivity analysis showed an ICER of $21,096.14/QALY. Interpretation These findings demonstrate that a suicide-prevention campaign in Ontario is very likely a cost-effective intervention to reduce the incidence of suicide and suggest suicide-prevention campaigns are likely to be cost effective for some other Canadian provinces and potentially other countries.

Suggested Citation

  • Michael Lebenbaum & Joyce Cheng & Claire Oliveira & Paul Kurdyak & Juveria Zaheer & Rebecca Hancock-Howard & Peter C. Coyte, 2020. "Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada," Applied Health Economics and Health Policy, Springer, vol. 18(2), pages 189-201, April.
  • Handle: RePEc:spr:aphecp:v:18:y:2020:i:2:d:10.1007_s40258-019-00511-5
    DOI: 10.1007/s40258-019-00511-5
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    References listed on IDEAS

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    1. Gray, Alastair M. & Clarke, Philip M. & Wolstenholme, Jane L. & Wordsworth, Sarah, 2010. "Applied Methods of Cost-effectiveness Analysis in Healthcare," OUP Catalogue, Oxford University Press, number 9780199227280.
    2. Robert Carroll & Chris Metcalfe & David Gunnell, 2014. "Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-9, February.
    3. Peter Tanuseputro & Walter P Wodchis & Rob Fowler & Peter Walker & Yu Qing Bai & Sue E Bronskill & Douglas Manuel, 2015. "The Health Care Cost of Dying: A Population-Based Retrospective Cohort Study of the Last Year of Life in Ontario, Canada," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-11, March.
    4. Matsubayashi, Tetsuya & Ueda, Michiko, 2011. "The effect of national suicide prevention programs on suicide rates in 21 OECD nations," Social Science & Medicine, Elsevier, vol. 73(9), pages 1395-1400.
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