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


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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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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Correspondence to Susan Ahern.

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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, L., 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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  • Suicide attempt
  • Suicidal ideation
  • Prevention
  • Intervention
  • Adolescents
  • School
  • Cost-effectiveness