Cost-effectiveness of a helpline for suicide prevention.

We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone-and a chat service. An age-and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone-as well as the chat service could avoid about 36% of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95% confidence interval, CI 0.030-0.097) and 0.035 QALYs (95% CI -0.026-0.096) were gained by users of the telephone-and chat service respectively. The corresponding values for females were 0.019 QALYs (95% CI -0.015-0.052) and a QALY-neutral result of -0.005 (95% CI -0.071-0.062). There were net societal savings of respectively (sic)2382 (95% CI 1953-2859) and (sic)2282 (95% CI 1855-2758) in male users; (sic)2171 (95% CI 1735-2664) and (sic)2458 (95% CI 1945-3025) in female users. At the population level, an investment of (sic)218,899 saved (sic)1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs.