Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| |
Authors: | Bregje AJ van Spijker M Cristina Majo Filip Smit Annemieke van Straten Ad JFM Kerkhof |
| |
Institution: | 1Department of Clinical Psychology and the EMGO+ Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands;2Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands;3Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands |
| |
Abstract: | BackgroundSuicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions.ObjectiveTo evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation.MethodsA total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009.ResultsAt post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 ? 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were ?€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be ?€5039/0.15 = ?€34,727 after rounding (US ?$41,325) for an additional treatment response, indicating annual cost savings per treatment responder.ConclusionsThis is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended. |
| |
Keywords: | suicidal ideation randomized controlled trial cost-effectiveness Internet cognitive behavior therapy |
|
|