Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;5(4):e226019.
doi: 10.1001/jamanetworkopen.2022.6019.

Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia

Piumee Bandara  1 , Jane Pirkis  2 , Angela Clapperton  2 , Sangsoo Shin  2 , Lay San Too  2 , Lennart Reifels  2 , Sandersan Onie  3   4 , Andrew Page  1 , Karl Andriessen  2 , Karolina Krysinska  2 , Anna Flego  2 , Marisa Schlichthorst  2 , Matthew J Spittal  2 , Cathrine Mihalopoulos  5 , Long Khanh-Dao Le  5
Affiliations

Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia

Piumee Bandara et al. JAMA Netw Open. .

Abstract

Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur.

Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia.

Design, setting, and participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model.

Interventions: Barriers installed at bridge and cliff sites.

Main outcomes and measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers.

Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95% uncertainty interval [UI], $90 to $160 million) could be saved in prevented suicides over 5 years, and US $270 million (95% UI, $176 to $298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used.

Conclusions and relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Pirkis reported receiving fellowship and grant funding from National Health and Medical Research Council and grant funding from Australian Institute of Health and Welfare outside the submitted work. Dr Too received fellowship funding from National Health and Medical Research Council outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Cost-effectiveness Plane of Installing Barriers at Known Bridge and Cliff Sites Where Suicides Have Occurred in Australia
See this image and copyright information in PMC

Comment in

References

    1. Australian Bureau of Statistics . Intentional self-harm deaths (Suicide) in Australia. In: Causes of Death. Australian Bureau of Statistics; 2021.
    1. Kinchin I, Doran CM. The economic cost of suicide and non-fatal suicide behavior in the Australian workforce and the potential impact of a workplace suicide prevention strategy. Int J Environ Res Public Health. 2017;14(4):347. doi:10.3390/ijerph14040347 - DOI - PMC - PubMed
    1. Pirkis J, Too LS, Spittal MJ, Krysinska K, Robinson J, Cheung YTD. Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis. Lancet Psychiatry. 2015;2(11):994-1001. doi:10.1016/S2215-0366(15)00266-7 - DOI - PubMed
    1. Pirkis J, Spittal MJ, Cox G, Robinson J, Cheung YTD, Studdert D. The effectiveness of structural interventions at suicide hotspots: a meta-analysis. Int J Epidemiol. 2013;42(2):541-548. doi:10.1093/ije/dyt021 - DOI - PubMed
    1. Okolie C, Wood S, Hawton K, et al. . Means restriction for the prevention of suicide by jumping. Cochrane Database Syst Rev. 2020;2(2):CD013543. doi:10.1002/14651858.CD013543 - DOI - PMC - PubMed

Publication types