Budget Impact Analysis of the Veterans Crisis Line Caring Letters Project

The Veterans Crisis Line (VCL) launched the Caring Letters (VCL-CL) suicide prevention intervention to support Veterans in crisis in 2020. The intervention mails messages of support to Veterans who contact the VCL and was associated with increased use of mental health services among recipients. VCL-CL might be implemented for other Veterans, but no information exists on the budget impact of a large-scale caring contacts intervention. This budget impact analysis evaluated the costs related to labor, supplies, and information technology during each phase (i.e., development, implementation, maintenance) of VCL-CL from January 2020 to May 2022. We also forecasted the per Veteran costs of sustaining VCL-CL for three years with varying levels of VCL-CL users. The cost of VCL-CL during the intervention development, implementation, and maintenance phase were $54,483, $602,534, and $967,174, respectively-for a total cost of $1,624,190. This represents approximately $10.94 per Veteran over the duration of the project, or $1.22 per Veteran-letter. The forecasted cost to sustain the VCL-CL project was less than $1.40 under all scenarios of Veteran use (stable use, 10% increase, 10% decrease). This evaluation identified the budget impact of the VCL-CL project, which may provide critical information for the Veterans Health Administration or other health systems when determining the financial feasibility of maintaining or implementing similar interventions. Although these findings are specific to VCL-CL, the relatively low per-Veteran cost suggests that such interventions may be feasible to implement and sustain in comparable settings.