Cost, Cost-Effectiveness, and Cost-Benefit of Collaborative Assessment and Management of Suicidality versus Enhanced Treatment as Usual

Suicide rates have been steadily increasing in both the U.S. general population and military, with significant psychological and economic consequences. One of the most empirically-supported suicide-focused interventions to date, the Collaborative Assessment and Management of Suicidality (CAMS), has demonstrated clinical effectiveness across a number of clinical trials. The purpose of the current study is to examine the economic costs, benefits, cost-effectiveness, and cost-benefit of CAMS versus enhanced treatment as usual (ETAU) in an active duty military sample using data from a recent randomized controlled trial of CAMS versus ETAU. Using a micro-costing approach, the cost of each condition was calculated at the individual level from a healthcare system perspective. Cost-effectiveness ratios, cost-benefit ratios, and net benefit were calculated and analyzed using general linear mixed modeling on multiply-imputed datasets. Treatment costs were comparable between conditions; both conditions were associated with significant clinical improvement. With respect to reducing suicidal ideation, CAMS evidenced significantly greater effectiveness and cost-effectiveness at 3-month follow-up. Cost per case resolved and cost per suicide attempt prevented were also lower in CAMS compared to ETAU. Further, CAMS was found to produce significantly greater benefit in the form of decreased healthcare expenditures at 6-month follow-up. CAMS also demonstrated significantly better cost-benefit and net benefit at 12-month follow-up, although neither condition evidenced significant healthcare cost savings after factoring in the cost of the intervention. The current study suggests that CAMS is an effective intervention for the treatment of suicidality in active duty service members with potential economic advantages over treatment as usual.