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Randomized Controlled Trial
. 2012 Oct 26;14(5):e141.
doi: 10.2196/jmir.1966.

Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help

Bregje A J van Spijker  1 , M Cristina Majo, Filip Smit, Annemieke van Straten, Ad J F M Kerkhof
Affiliations
Randomized Controlled Trial

Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help

Bregje A J van Spijker et al. J Med Internet Res. .

Abstract

Background: Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions.

Objective: To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation.

Methods: A 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.

Results: At 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.

Conclusions: This 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.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Flowchart of participants in the trial.
Figure 2
Figure 2
Distribution of bootstrapped incremental cost-effectiveness ratios (ICERs) (n = 2500) on the cost-effectiveness plane, primary analysis.
Figure 3
Figure 3
Incremental cost-effectiveness ratio (ICER) acceptability curve: Probability that the intervention is acceptable relative to care as usual (y-axis) given varying thresholds for willingness to pay (x-axis) based on 2500 bootstrap replications.
See this image and copyright information in PMC

References

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