Collaborative Assessment and Management of Suicidality in the Aftercare Focus Study: Costs, Benefits, Cost-Effectiveness, and Cost-Benefit

Previous data from a randomized controlled trial suggest that the Collaborative Assessment and Management of Suicidality (CAMS) is more effective than standard care (SC) in reducing suicidal ideation, symptom distress, and hopelessness in suicidal patients treated within a "next-day appointment" setting following psychiatric hospitalization. The current study sought to examine the economic costs, benefits, cost-effectiveness, and cost-benefit of CAMS versus SC in a larger replication randomized controlled trial. The cost of delivering each treatment was estimated at the individual level from the healthcare system, patient, and overall perspectives. Benefits were assessed based on healthcare expenditure cost savings and reduced wage loss. Effectiveness-cost ratios, cost-benefit ratios, and net benefit were calculated and analyzed using generalized linear modeling. Treatment costs were significantly lower in CAMS from all perspectives at 3-, 6-, and 12-month follow-ups. Both conditions improved with respect to suicidal ideation and behavior; treatment effects were comparable with the exception of CAMS participants evidencing significantly lower suicidal ideation severity at 12 months. Effectiveness-cost ratios for suicidal ideation improvement were significantly higher in CAMS at 6-month follow-up from the patient perspective and at 12-month follow-up from all three perspectives; there were no significant group differences with respect to suicidal behaviors. Treatment conditions produced equivalent benefit and net benefit; however, CAMS was associated with significantly greater cost-benefit from the healthcare and overall perspectives. The current study suggests that CAMS is an effective intervention for the treatment of suicidality within a next-day appointment setting and may have economic advantages over standard care.