Implementing psychological care in emergency departments for suicide prevention

Table 3 Cost-effectiveness analysis of emergency department-based suicide prevention interventions

Intervention	Incremental cost per patient	Effectiveness (suicide attempts averted)	Cost per life-year saved	Population impact	Key studies
Universal screening + telephone intervention	$500 more than screening alone	10% reduction in attempts/deaths at 12 months	$4300 per life-year saved	Potential savings of $840M annually if 25% of attempts averted	ED-SAFE cost analysis[11]
Postcard/caring letters	Cost-saving compared to usual care	Significant reduction in repeat attempts	Dominant strategy (improves outcomes, reduces costs)	Low-cost, scalable population-level intervention	Modeling studies[60,61]
Safety planning intervention	$1063 per month per patient (telehealth model)	Reduced suicidal behavior and healthcare utilization	To be determined in ongoing trials	Potential for system-wide cost offsets through reduced acute care	SPCC trial protocol[40]
Cognitive behavioral therapy	$18800 per life-year saved	41%-54% reduction in repeat attempts	Cost-effective at WTP ≥ $50000 per life-year	Targeted approach for high-risk populations	Economic evaluation[26,27]
Brief contact interventions	Minimal incremental cost	24% reduced relapse risk with early appointment	Highly cost-effective	Can be integrated into existing follow-up systems	Observational studies[31]

ED: Emergency department; SAFE: Suicide assessment follow-up and engagement; SPCC: Suicide Prevention and Crisis Center; WTP: Willingness to pay.