COSTS, BENEFITS, AND QUALITY-ADJUSTED LIFE YEARS OF A LIFELINE CRISIS CENTER, 2009 THROUGH 2013

Abstract: This is the first study to assess costs and benefits for suicide hotlines after the national standardization of Lifeline. We obtained data from a Lifeline center from 2009 through 2013. We hypothesized that Lifeline improved allocation of emergency department (ED) resources by accurately screening callers and reducing unnecessary ED visits. We also hypothesized that Lifeline increases Quality Adjusted Life Years (QALYs) for high-risk callers, and at an acceptable cost. Methods: Costs were calculated using Lifeline expenditure reports for suicide-related calls. ED and work loss costs were extracted from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project dataset and the Centers for Disease Control Web-based Injury Statistics Query and Reporting System. QALYs were calculated using World Health Organization (WHO) data. For minimum, most-likely, and best-case scenarios, probabilistic sensitivity analyses examined financial impacts of reducing ED visits, of QALYs gained, and cost per QALY gained. Results: For benefits/costs of prevented ED visits, most-likely (2.33 [CI = 2.09, 2.57] and maximum best-case scenarios (2.99 [CI = 2.83, 3.15]) were significantly (p < .01) better than the null hypothesis of benefit/cost = 1. Cost per QALY gained was $12,569 per QALY [CI = $11,090, $13,908], substantially below the WHO threshold of $50,000 for funding of health initiatives. Conclusion: Economic impacts of the Lifeline center were moderately positive: costs likely saved by Lifeline for ED treat and release were sufficient to pay for all Lifeline services, plus cost per QALY gained was affordably low compared to other health services.