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

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.

journal_name

Appl Health Econ Health Policy

journal_title

Applied health economics and health policy

authors

Lebenbaum M,Cheng J,de Oliveira C,Kurdyak P,Zaheer J,Hancock-Howard R,Coyte PC

doi

10.1007/s40258-019-00511-5

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

189-201

issue

eissn

1175-5652

issn

1179-1896

pii

10.1007/s40258-019-00511-5

journal_volume

pub_type

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