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

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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.

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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.

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Authors and Affiliations

  1. Centre for Policy Studies, Cork University Business School, University College Cork, Cork, Ireland

    Susan Ahern

  2. Cork University Business School, University College Cork, Cork, Ireland

    Lee-Ann Burke & Brendan McElroy

  3. National Suicide Research Foundation, Cork, Ireland

    Paul Corcoran & Elaine M. McMahon

  4. Child and Adolescent Mental Health Service, Health Service Executive, Mallow, Cork, Ireland

    Helen Keeley

  5. National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden

    Vladimir Carli, Camilla Wasserman & Danuta Wasserman

  6. WHO Collaborating Centre for Training, Research and Methods Development in Suicide Prevention, Stockholm, Sweden

    Vladimir Carli, Camilla Wasserman & Danuta Wasserman

  7. Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Camilla Wasserman & Christina W. Hoven

  8. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Christina W. Hoven

  9. Department of Medicine and Health Science, University of Molise, Campobasso, Italy

    Marco Sarchiapone

  10. National Institute for Health, Migration and Poverty, Rome, Italy

    Marco Sarchiapone

  11. Schneider Children’s Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel

    Alan Apter

  12. Institute of Psychology, Eötvös Loránd University, Budapest, Hungary

    Judit Balazs & Agnes Kereszteny

  13. Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary

    Judit Balazs

  14. Doctoral School of Semmelweis University, Budapest, Hungary

    Agnes Kereszteny

  15. Addiction Help Services B.I.N., Anichstraße 34, Innsbruck, Austria

    Raphaela Banzer & Christian Haring

  16. Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria

    Christian Haring

  17. University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain

    Julio Bobes & Pilar A. Sáiz

  18. Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany

    Romuald Brunner & Michael Kaess

  19. Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

    Doina Cosman

  20. Department of Psychiatry, CHRU de NANCY and Pole 6, Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France

    Jean-Pierre Kahn

  21. Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia

    Vita Postuvan

  22. Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia

    Peeter Varnik

Authors
  1. Susan Ahern
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  2. Lee-Ann Burke
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  3. Brendan McElroy
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  4. Paul Corcoran
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  5. Elaine M. McMahon
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  6. Helen Keeley
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  7. Vladimir Carli
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  8. Camilla Wasserman
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  9. Christina W. Hoven
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  10. Marco Sarchiapone
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  11. Alan Apter
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  12. Judit Balazs
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  13. Raphaela Banzer
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  14. Julio Bobes
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  15. Romuald Brunner
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  16. Doina Cosman
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  17. Christian Haring
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  18. Michael Kaess
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  19. Jean-Pierre Kahn
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  20. Agnes Kereszteny
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  21. Vita Postuvan
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  22. Pilar A. Sáiz
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  23. Peeter Varnik
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  24. Danuta Wasserman
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Corresponding author

Correspondence to Susan Ahern.

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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.

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Ahern, S., Burke, LA., McElroy, B. et al. A cost-effectiveness analysis of school-based suicide prevention programmes. Eur Child Adolesc Psychiatry 27, 1295–1304 (2018). https://doi.org/10.1007/s00787-018-1120-5

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  • DOI: https://doi.org/10.1007/s00787-018-1120-5

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