Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help
BackgroundSuicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. ObjectiveTo evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. MethodsA tota...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2012-10-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | http://www.jmir.org/2012/5/e141/ |
| _version_ | 1831665336229822464 |
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| author | van Spijker, Bregje A.J Majo, M. Cristina Smit, Filip van Straten, Annemieke Kerkhof, Ad J.F.M |
| author_facet | van Spijker, Bregje A.J Majo, M. Cristina Smit, Filip van Straten, Annemieke Kerkhof, Ad J.F.M |
| author_sort | van Spijker, Bregje A.J |
| collection | DOAJ |
| description | BackgroundSuicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions.
ObjectiveTo evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation.
MethodsA 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.
ResultsAt 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.
ConclusionsThis 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. |
| first_indexed | 2024-12-19T19:32:50Z |
| format | Article |
| id | doaj.art-c597be7cf82244d1b2fceb4998c4caf5 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-12-19T19:32:50Z |
| publishDate | 2012-10-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-c597be7cf82244d1b2fceb4998c4caf52022-12-21T20:08:33ZengJMIR PublicationsJournal of Medical Internet Research1438-88712012-10-01145e14110.2196/jmir.1966Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-helpvan Spijker, Bregje A.JMajo, M. CristinaSmit, Filipvan Straten, AnnemiekeKerkhof, Ad J.F.MBackgroundSuicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. ObjectiveTo evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. MethodsA 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. ResultsAt 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. ConclusionsThis 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.http://www.jmir.org/2012/5/e141/ |
| spellingShingle | van Spijker, Bregje A.J Majo, M. Cristina Smit, Filip van Straten, Annemieke Kerkhof, Ad J.F.M Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help Journal of Medical Internet Research |
| title | Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| title_full | Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| title_fullStr | Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| title_full_unstemmed | Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| title_short | Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help |
| title_sort | reducing suicidal ideation cost effectiveness analysis of a randomized controlled trial of unguided web based self help |
| url | http://www.jmir.org/2012/5/e141/ |
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