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.

Assessing direct healthcare costs when restricted to self-reported data: a scoping review.

BACKGROUND: In the absence of electronic health records, analysis of direct healthcare costs often relies on resource utilisation data collected from patient-reported surveys. This scoping review explored the availability, use and methodological details of self-reported healthcare service utilisation and cost data to assess healthcare costs in Ireland. METHODS: Population health surveys were identified from Irish data repositories and details were collated in an inventory to inform the literature search. Irish cost studies published in peer-reviewed and grey sources from 2009 to 2019 were included if they used self-reported data on healthcare utilisation or cost. Two independent researchers extracted studies' details and the PRISMA-ScR guidelines were used for reporting. RESULTS: In total, 27 surveys were identified containing varying details of healthcare utilisation/cost, health status, demographic characteristics and health-related risk and behaviour. Of those surveys, 21 were general population surveys and six were study-specific ad-hoc surveys. Furthermore, 14 cost studies were identified which used retrospective self-reported data on healthcare utilisation or cost from ten of the identified surveys. Nine of these cost studies used ad-hoc surveys and five used data from pre-existing population surveys. Compared to population surveys, ad-hoc surveys contained more detailed information on resource use, albeit with smaller sample sizes. Recall periods ranged from 1 week for frequently used services to 1 year for rarer service use, or longer for once-off costs. A range of perspectives (societal, healthcare and public sector) and costing approaches (bottom-up costing and a mix of top-down and bottom-up) were used. The majority of studies (n = 11) determined unit prices using multiple sources, including national healthcare tariffs, literature and expert views. Moreover, most studies (n = 13) reported limitations concerning data availability, risk of bias and generalisability. Various sampling, data collection and analysis strategies were employed to minimise these. CONCLUSION: Population surveys can aid cost assessments in jurisdictions that lack electronic health records, unique patient identifiers and data interoperability. To increase utilisation, researchers wanting to conduct cost analyses need to be aware of and have access to existing data sources. Future population surveys should be designed to address reported limitations and capture comprehensive health-related, demographic and resource use data.