ED-SAFE intervention cost effective for suicide prevention

2019 ◽  
Vol 837 (1) ◽  
pp. 14-14
Keyword(s):  
Suicide Prevention ◽  
Cost Effective ◽  
Intervention Cost ◽  
Safe Intervention

Study protocol for the Multimodal Approach to Preventing Suicide in Schools (MAPSS) project: A regionally-based trial of an integrated response to suicide risk among secondary school students.

2021 ◽  
Author(s):  
Sadhbh Josephine Byrne ◽  
Eleanor Bailey ◽  
Michelle Lamblin ◽  
Jane Pirkis ◽  
Cathrine Mihalopoulos ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Prevention Program ◽  
Help Seeking ◽  
Suicide Risk ◽  
Best Practice ◽  
Controlled Trial ◽  
Case Series ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
School Students

Abstract Background Suicide is the leading cause of death among young Australians, accounting for one-third of all deaths in those under 25. Schools are a logical setting for youth suicide prevention activities, with universal, selective and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programs combine these approaches, and that to date this has not been done in school settings, this study aims to evaluate a suicide prevention program incorporating universal, selective and indicated components in schools.Methods This study is a trial of a multimodal suicide prevention program for young people. The program involves delivering universal psychoeducation (safeTALK) to all students, screening them for suicide risk, and delivering internet-based Cognitive Behavioural Therapy (Reframe IT) to those students identified as being at high risk for suicide. The program will be trialled in secondary schools in Melbourne, Australia, and target year 10 students (15 and 16 year-olds). safeTALK and screening will be evaluated using a single group pre-test/post-test case series, and Reframe IT will be evaluated in a Randomised Controlled Trial. The primary outcome is change in suicidal ideation; other outcomes include help-seeking behaviour and intentions, and suicide knowledge and stigma. The program’s cost-effectiveness will also be evaluated.Discussion This study is the first to evaluate a suicide prevention program comprising universal, selective and indicated components in Australian schools. If the program is found to be efficacious and cost-effective, it could be more widely disseminated in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in school students across the region.

scholarly journals Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

2020 ◽  
pp. 070674372098013
Author(s):  
Gonzalo Martínez-Alés ◽  
José B. Cruz Rodríguez ◽  
Pablo Lázaro ◽  
Arce Domingo-Relloso ◽  
María Luisa Barrigón ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Suicide Prevention ◽  
Cost Effective ◽  
Cost Data ◽  
Base Case ◽  
Case Scenario ◽  
Post Discharge ◽  
Base Case Scenario ◽  
Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

scholarly journals The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK

2019 ◽  
Vol 74 (Supplement_5) ◽  
pp. v5-v16 ◽  
Author(s):  
Zoe Ward ◽  
Linda Campbell ◽  
Julian Surey ◽  
Steven Platts ◽  
Rachel Glass ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Drug Treatment ◽  
Peer Support ◽  
Secondary Care ◽  
Cost Effective ◽  
List Price ◽  
Housing Status ◽  
Intervention Cost ◽  
The Cost

Abstract Background HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. Objectives To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care). Methods Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon. Results For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY). Conclusions New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.

A Non-inferiority Framework for Cost-Effectiveness Analysis

2019 ◽  
Vol 35 (4) ◽  
pp. 291-297
Author(s):  
Xuanqian Xie ◽  
Lindsey Falk ◽  
James M. Brophy ◽  
Hong Anh Tu ◽  
Jennifer Guo ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Active Control ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cost Effective ◽  
Placebo Control ◽  
Decision Framework ◽  
Life Years ◽  
Intervention Cost ◽  
New Framework

AbstractBackgroundTraditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression.MethodsWe modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP).ResultsrTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively.ConclusionsThis new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.

Abstract 173: Simple Guidance Improves Appropriate Telemetry Utilization

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alekhya Potluri ◽  
Mrudula Kudaravalli ◽  
Anthony Defail ◽  
Dilip Prabhakaran ◽  
Sangita Prabhakaran ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Guideline Implementation ◽  
Heart Association ◽  
Limited Resource ◽  
Cost Effective ◽  
Post Intervention ◽  
Qt Interval Prolongation ◽  
Intervention Cost ◽  
Before And After ◽  
Bed Days

Introduction: Cardiac telemetry is an in-hospital monitoring tool intended for ischemia surveillance, monitor QT-interval prolongation, and detect arrhythmias. It is a costly and limited resource that is frequently misused. Inappropriate telemetry use can lead to prolonged hospital stays, patient discomfort, alarm fatigue, and increased healthcare costs. We designed and implemented a telemetry guideline independent of the electronic health record (EHR) in an attempt to increase appropriate telemetry use in non-intensive care unit (ICU) setting Objectives: To design and implement a telemetry guideline. To increase appropriate use of telemetry. To practice cost-conscious, high-value care Aim: Primary Aim: Implement a telemetry guideline using pocket cards and educational conferences and monitor telemetry assignments Secondary Aim: Assess patient outcomes as reflected by the number of codes before and after the intervention Methods: We adopted telemetry criteria based on the American Heart Association guidelines from 2004 and other published literature. Baseline data was collected in November 2015 for all medicine teaching team admissions at our institution that came through the emergency department. Exclusion criteria were ICU transfers, step-down units, and direct admissions. Guidelines were then implemented via educational conferences and pocket card distribution to ED physicians, admitting hospitalists and medicine residents. Post-intervention data was collected from February through March 2016 Results: Of 180 admissions prior to guideline implementation, 93 patients (52%) went to non-telemetry beds and 87 patients (48%) to telemetry beds. Of the telemetry admissions, 60 patients (69%) were appropriately assigned to telemetry while 27 (31%) were not. After the guideline was implemented, 255 patients were reviewed. Of these, 110 (43%) went to telemetry beds, and 86 patients (78%) were appropriately assigned while 24 patients (22%) were not. There was no significant increase or decrease in the number of codes post intervention. Cost analysis revealed 103 telemetry-bed-days saved per month Conclusion: Our intervention resulted in a large (9.1%) but statistically insignificant increase in appropriate telemetry use. Although statistically insignificant, this improvement was durable across two months. Cost analysis revealed 103 telemetry-bed-days saved per month with an estimated savings of $100,000 in unnecessary charges. The relatively simple and cost-effective intervention of creating and implementing a telemetry assignment guideline was effective in changing telemetry ordering behavior. This was done without telemetry assignment logic in the EHR, which can be a tedious and time-consuming endeavor. Future efforts will include the implementation of a telemetry auditing tool, and ultimately the embedded logic to facilitate ordering practices.

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