Economic Evaluation of Dialectical Behavioral Therapy Versus Cognitive Behavioral Therapy for Suicide Prevention.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death for adults aged 18-64 in the United States, and suicide risk is highest among those with previous attempts. Two evidence-based treatments for suicide prevention exist dialectical behavioral therapy (DBT), a year-long intensive treatment, and cognitive behavioral therapy (CBT), a brief (10-12 session) treatment. To our knowledge, no direct comparison of the two treatments yet exists AIMS: To analyze the cost-effectiveness of DBT compared to CBT, in terms of both cost and quality of life, for the prevention of future suicide attempt among previous attempters. METHODS: A Markov Model was developed to estimate the incremental cost-effectiveness ratio (ICER) in 2022 US dollars per quality-adjusted life-year (QALY). Published literature was reviewed to identify parameter estimates. The target population was US adults aged 18-64 with a previous suicide attempt. A time horizon of one year was used, and costs were calculated from the health care system perspective. RESULTS: Compared to CBT, DBT is associated with an estimated incremental cost of USD26,362 per QALY gained. One-way sensitivity analysis (OWSA) revealed consistent results, with DBT being cost-effective in most cases at a maximum threshold of USD50,000 per QALY. DISCUSSION: Results suggest that, compared to CBT, DBT is associated with comparable costs and mortality but higher quality of life. Due to the limited evidence base, caution is recommended when interpreting and generalizing results. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Given comparable cost and efficacy, patient preference for CBT or DBT must be incorporated in treatment selection. Ensuring patients play an active role in treatment selection has the potential to lead to improved clinical and health system outcomes. IMPLICATIONS FOR HEALTH POLICIES As manualized treatments, both DBT and CBT are appropriate for trained master's level clinicians to deliver. Allowing master's level clinicians to provide evidence-based care for suicide prevention may be a cost-effective strategy for quality service provision. IMPLICATIONS FOR FUTURE RESEARCH Future research grounded in conceptual theories of suicide that distinguish suicide risk from more general psychiatric risks are needed.