Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions
Screening and Intervention for Suicide Prevention: A Cost-Effectiveness Analysis of the ED-SAFE Interventions
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DOI：
10.1176/appi.ps.201800445
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发表时间：
2019-12-01
影响因子：
3.8
通讯作者：
Boudreaux, Edwin D.
中科院分区：
文献类型：
--
作者：
Dunlap, Laura J.;Orme, Stephen;Boudreaux, Edwin D.
目的：自杀筛查后的干预可能会识别出有自杀倾向的个体，并防止复发的自我伤害，但很少进行成本效益研究。本研究旨在确定在医院急诊科（ed）实施筛查和干预的成本增加是否因患者结果的改善（减少自杀企图和自杀死亡）而合理。方法：2010年8月至2013年11月，急诊科安全评估和随访评估（ED-SAFE）研究招募了8名美国急诊科的参与者。8个地点依次实施了两种干预措施：在常规治疗的基础上进行普遍筛查，以及在ed就诊后12个月内进行普遍筛查加电话干预。本研究计算了增量成本-效果比和成本-效果可接受性曲线，以评估筛查和自杀结果措施以及两种干预措施相对于常规治疗的成本。从提供者的角度（例如，工资和薪金数据以及医院空间的租金费用）计算每个病人和每个场地的费用。结果：参加全面筛查加干预的ED的平均每位患者费用为每月1063美元，比常规治疗中加入全面筛查的ED大约多出500美元。普遍筛查加干预在预防自杀方面比普遍筛查加常规治疗和单独常规治疗更有效。结论：虽然普遍筛查加干预的选择取决于决策者对结果的重视程度，但结果表明，实施这种自杀预防措施可以显著节省成本。
Objective: Suicide screening followed by an intervention may identify suicidal individuals and prevent recurring self-harm, but few cost-effectiveness studies have been conducted. This study sought to determine whether the increased costs of implementing screening and intervention in hospital emergency departments (EDs) are justified by improvements in patient outcomes (decreased attempts and deaths by suicide).Methods: The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study recruited participants in eight U.S. EDs between August 2010 and November 2013. The eight sites sequentially implemented two interventions: universal screening added to treatment as usual and universal screening plus a telephone-based intervention delivered over 12 months post-ED visit. This study calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves to evaluate screening and suicide outcome-measures and costs for the two interventions relative to treatment as usual. Costs were calculated from the provider perspective (e.g., wage and salary data and rental costs for hospital space) per patient and per site.Results: Average per-patient costs to a participating ED of universal screening plus intervention were $1,063 per month, approximately $500 more than universal screening added to treatment as usual. Universal screening plus intervention was more effective in preventing suicides compared with universal screening added to treatment as usual and treatment as usual alone.Conclusions: Although the choice of universal screening plus intervention depends on the value placed on the outcome by decision makers, results suggest that implementing such suicide prevention measures can lead to significant cost savings.