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



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.


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.


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.


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.

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Data availability

Data are available from the authors upon request.


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Authors and Affiliations



JC and ML are dual first authors for this article. JC and ML conceived the study, undertook the analysis, and wrote the manuscript. All authors assisted with the interpretation of the results and critically reviewed the manuscript.

Corresponding authors

Correspondence to Michael Lebenbaum or Joyce Cheng.

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The research presented in this article was not funded by any study-specific Grant funding. Michael Lebenbaum is funded by a Vanier Canada Graduate Scholarship.

Conflict of interest

Joyce Cheng, Michael Lebenbaum, Claire de Oliveira, Paul Kurdyak, Juveria Zaheer, and Peter C. Coyte have no conflicts of interests to declare. Rebecca Hancock-Howard was previously employed as a consultant at Amaris, a private firm; clients include pharmaceutical companies and medical device manufacturers.

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Lebenbaum, M., Cheng, J., de Oliveira, C. et al. Evaluating the Cost Effectiveness of a Suicide Prevention Campaign Implemented in Ontario, Canada. Appl Health Econ Health Policy 18, 189–201 (2020).

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