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Outcomes and Cost-Benefit of a National Suicide Reattempt Prevention Program
Yves Gallien1, Sandrine Broussouloux1, Alice Demesmaeker2
1Santé Publique France, French National Public Health Agency, Saint Maurice, France.
Importance:
Suicide attempts (SA) are a major public health concern and a preventable cause of premature death with a significant societal cost. Suicide reattempt (SR) rates are high in the postdischarge period for an SA. Brief contact interventions (BCIs) aim to prevent SR by recontacting patients after discharge through crisis cards, calls, letters, or messages. A nationwide BCI was deployed in 6 French regions between 2015 and 2017.
Objective:
To assess the outcomes and the cost benefit of the program in reducing SR risk within 12 months after discharge.
Design, Setting, And Participants:
Retrospective multicenter cohort study using nationwide data from the French health insurance database and emergency department surveillance system. Patients exposed to the program between 2015 and 2017 were matched 1:1 with unexposed patients based on age, sex, history of SA, and diagnosis codes using propensity scores and followed up for 12 months. Survival and cost-benefit analyses were conducted in [month to month] 2022.
Exposure:
Participation in the program, including structured follow-up using crisis cards, telephone calls, and/or postcards for up to 6 months after discharge.
Main Outcomes And Measures:
The primary outcome was time to first SR or suicide-related death within 12 months. The secondary outcome was the number of SRs and cost savings.
Results:
Among 23 146 individuals, 14 504 (62.6%) were female, 12 244 (52.9%) had no history of SA, and the mean (SD) age was 39 (17) years. Exposure to the program was associated with a lower risk of SR (adjusted hazard ratio [aHR], 0.62; 95% CI, 0.59-0.67). This association was consistent regardless of patients' history of SAs (aHR, 0.63; 95% CI, 0.57-0.71 for those without prior attempts; aHR, 0.61; 95% CI, 0.56-0.66 for those with prior attempts) and appeared greater among female participants (aHR, 0.59; 95% CI, 0.54-0.68) than male participants (aHR, 0.68; 95% CI, 0.61-0.76). The program yielded a return on investment of €2.06 (95% CI, €1.58-€2.50) per euro spent.
Conclusion And Relevance:
In this cohort study, exposure to the program was associated with a reduced risk of SR and favorable economic outcomes.
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