RTI International, Research Triangle Park, North Carolina (Dunlap, Orme, Zarkin); Department of Psychiatry and Human Behavior, Brown University and Butler Hospital, Providence, Rhode Island (Arias, Miller); Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Camargo, Sullivan); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Allen); Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, Bethesda, Maryland (Goldstein); Center for Behavioral Health Services, Cape Cod Hospital, Hyannis, Massachusetts (Manton); Department of Quantitative Health Sciences and Department of Family Medicine, University of Massachusetts Medical School, Worcester (Clark); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Boudreaux).
Psychiatr Serv. 2019 Dec 1;70(12):1082-1087. doi: 10.1176/appi.ps.201800445. Epub 2019 Aug 27.
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).
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.
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.
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.
自杀筛查后进行干预可能会发现有自杀倾向的个体，并防止再次自残，但很少有成本效益研究。本研究旨在确定在医院急诊部实施筛查和干预是否会增加成本，而患者的结局（自杀未遂和死亡的减少）是否会得到改善。
急诊部安全评估和随访评估（ED-SAFE）研究于 2010 年 8 月至 2013 年 11 月期间在美国 8 个急诊部招募了参与者。这 8 个地点依次实施了两项干预措施：在常规治疗基础上增加普遍筛查和在常规治疗基础上增加为期 12 个月的电话干预。本研究计算了增量成本效益比和成本效益可接受性曲线，以评估两种干预措施的筛查和自杀结局指标以及与常规治疗相比的成本。成本是根据患者和每个地点的提供者视角（例如工资和薪资数据以及医院空间的租金成本）计算的。
与在常规治疗基础上增加普遍筛查相比，每月对参与的急诊部实施普遍筛查加干预的平均每位患者的费用为 1063 美元，大约增加了 500 美元。与在常规治疗基础上增加普遍筛查相比，普遍筛查加干预在预防自杀方面更为有效，且与常规治疗相比也更有效。
尽管选择普遍筛查加干预取决于决策者对结果的重视程度，但结果表明，实施这些自杀预防措施可能会带来显著的成本节约。
