Elsevier

Journal of Affective Disorders

Volume 186, 1 November 2015, Pages 203-210
Journal of Affective Disorders

Research report
Training mental health professionals in suicide practice guideline adherence: Cost-effectiveness analysis alongside a randomized controlled trial

https://doi.org/10.1016/j.jad.2015.07.028Get rights and content
Under a Creative Commons license
open access

Highlights

  • First randomized trial on cost-effectiveness of a suicide guideline implementation.

  • The intervention was not cost-effective when analyzing all suicidal patients.

  • The intervention may be considered cost-effective for depressed suicidal patients.

  • We heavily relied on statistical techniques to impute the missing data.

  • Diagnoses were not derived from structured clinical interviews.

Abstract

Background

There is a lack of information on the cost-effectiveness of suicide prevention interventions. The current study examines the cost-effectiveness of a multifaceted structured intervention aiming to improve adherence to the national suicide practice guideline in comparison with usual implementation.

Methods

In the intervention condition, professionals of psychiatric departments were trained using an e-learning supported Train-the-Trainer program. Newly admitted suicidal patients were assessed as soon as their department was trained and at 3 months follow-up. The primary outcome was improvement in suicide ideation. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes were plotted, and cost-effectiveness acceptability curves were estimated.

Results

For the total group of suicidal patients (n=566), no effect of the intervention on suicide ideation or costs was found. For a subgroup of depressed suicidal patients (n=154, intervention=75, control=79), mean level of suicide ideation decreased with 2.7 extra points in the intervention condition, but this was not statistically significant. For this subgroup, the intervention may be considered cost-effective in comparison with usual implementation if society is willing to pay≥€ 6100 per unit of effect on the suicide ideation scale extra.

Limitations

Considering the cost outcomes, we had almost no cases that were complete, and heavily relied on statistical techniques to impute the missing data. Also, diagnoses were not derived from structured clinical interviews.

Conclusions

We presented the first randomized trial (trial registration: The Netherlands Trial Register (NTR3092 www.trialregister.nl)) on cost-effectiveness of a suicide practice guideline implementation in mental health care. The intervention might be considered cost-effective for depressed suicidal patients if society is willing to make substantial investments.

Abbreviations

IAU
Implementation as usual
MHI
Mental Health Institution
PGSB
Multidisciplinary practice guideline for the assessment and treatment of suicidal behavior
PITSTOP
Professionals In Training to STOP suicide
TtT-e
E-learning supported Train-the-Trainer program
CEA
cost effectiveness analysis
EMGO
Dutch Institute for Health and Care institute
ROM
Routine Outcome Monitoring
TiC-P
Trimbos questionnaire for costs associated with psychiatric illness
ICER
Incremental Cost Effectiveness Ratio
QALY
Quality-adjusted life years
BSS
Beck Scale for Suicide Ideation

Keywords

Cost-effectiveness
Quality of life
Suicide
Guideline
Implementation
Train-the-trainer

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