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A cost-effectiveness analysis of school-based suicide prevention programmes

  • Susan Ahern
  • Lee-Ann Burke
  • Brendan McElroy
  • Paul Corcoran
  • Elaine M. McMahon
  • Helen Keeley
  • Vladimir Carli
  • Camilla Wasserman
  • Christina W. Hoven
  • Marco Sarchiapone
  • Alan Apter
  • Judit Balazs
  • Raphaela Banzer
  • Julio Bobes
  • Romuald Brunner
  • Doina Cosman
  • Christian Haring
  • Michael Kaess
  • Jean-Pierre Kahn
  • Agnes Kereszteny
  • Vita Postuvan
  • Pilar A. Sáiz
  • Peeter Varnik
  • Danuta Wasserman
Original Contribution

Abstract

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer’s perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.

Trial registration number DRKS00000214.

Keywords

Suicide attempt Suicidal ideation Prevention Intervention Adolescents School Cost-effectiveness 

Notes

Funding

The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Programme (FP7). Grant agreement number HEALTH-F2-2009-223091. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author (SA) had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

The SEYLE study was approved ethically by the European Commission as a precondition of funding approval for the project. Ethical permission for the project, including permission to follow-up individual pupils was obtained in each participating country by the Research Ethics Committees. All requirements of obtaining Informed Consent from pupils and parents were followed carefully.

Supplementary material

787_2018_1120_MOESM1_ESM.docx (202 kb)
Supplementary material 1 (DOCX 201 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Susan Ahern
    • 1
  • Lee-Ann Burke
    • 2
  • Brendan McElroy
    • 2
  • Paul Corcoran
    • 3
  • Elaine M. McMahon
    • 3
  • Helen Keeley
    • 4
  • Vladimir Carli
    • 5
    • 6
  • Camilla Wasserman
    • 5
    • 6
    • 7
  • Christina W. Hoven
    • 7
    • 8
  • Marco Sarchiapone
    • 9
    • 10
  • Alan Apter
    • 11
  • Judit Balazs
    • 12
    • 13
  • Raphaela Banzer
    • 15
  • Julio Bobes
    • 17
  • Romuald Brunner
    • 18
  • Doina Cosman
    • 19
  • Christian Haring
    • 15
    • 16
  • Michael Kaess
    • 18
  • Jean-Pierre Kahn
    • 20
  • Agnes Kereszteny
    • 12
    • 14
  • Vita Postuvan
    • 21
  • Pilar A. Sáiz
    • 17
  • Peeter Varnik
    • 22
  • Danuta Wasserman
    • 5
    • 6
  1. 1.Centre for Policy Studies, Cork University Business SchoolUniversity College CorkCorkIreland
  2. 2.Cork University Business SchoolUniversity College CorkCorkIreland
  3. 3.National Suicide Research FoundationCorkIreland
  4. 4.Child and Adolescent Mental Health Service, Health Service ExecutiveCorkIreland
  5. 5.National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska InstitutetStockholmSweden
  6. 6.WHO Collaborating Centre for Training, Research and Methods Development in Suicide PreventionStockholmSweden
  7. 7.Department of Child and Adolescent Psychiatry, New York State Psychiatric InstituteColumbia UniversityNew YorkUSA
  8. 8.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  9. 9.Department of Medicine and Health ScienceUniversity of MoliseCampobassoItaly
  10. 10.National Institute for Health, Migration and PovertyRomeItaly
  11. 11.Schneider Children’s Medical Centre of IsraelTel-Aviv UniversityTel AvivIsrael
  12. 12.Institute of PsychologyEötvös Loránd UniversityBudapestHungary
  13. 13.Vadaskert Child and Adolescent Psychiatry HospitalBudapestHungary
  14. 14.Doctoral School of Semmelweis UniversityBudapestHungary
  15. 15.Addiction Help Services B.I.N.InnsbruckAustria
  16. 16.Department Psychiatry and PsychotherapyTirol Kliniken, Hospital Hall in TyrolInnsbruckAustria
  17. 17.University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)OviedoSpain
  18. 18.Department of Child and Adolescent Psychiatry, Centre for Psychosocial MedicineUniversity of HeidelbergHeidelbergGermany
  19. 19.Clinical Psychology DepartmentIuliu Hatieganu University of Medicine and PharmacyCluj-NapocaRomania
  20. 20.Department of PsychiatryCHRU de NANCY and Pole 6, Centre Psychothérapique de Nancy, Université de LorraineNancyFrance
  21. 21.Slovene Centre for Suicide Research, Andrej Marusic InstituteUniversity of PrimorskaKoperSlovenia
  22. 22.Estonian-Swedish Mental Health and Suicidology InstituteTallinnEstonia

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