Reducing suicidal ideation: Cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help

Background: suicidal ideation is highly prevalent,but often remains untreated. the internet can be used to provide accessible interventions. objective: to evaluate the cost-effectiveness of an online,unguided,self-help intervention for reducing suicidal ideation. methods: a total of 236 adults with mild to moderate suicidal thoughts,defined as scores between 1-26 on the beck scale for suicide ideation (bss),were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist,information-only,control group (n = 120). the intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. participants in both groups had unrestricted access to care as usual. assessments took place at baseline and 6 weeks later (post-test). all questionnaires were self-report and administered via the internet. treatment response was defined as a clinically significant decrease in suicidal ideation on the bss. total per-participant costs encompassed costs of health service uptake,participants' out-of-pocket expenses,costs stemming from production losses,and intervention costs. these were expressed in euros (€) for the reference year 2009. results: at post-test,treatment response was 35.3% and 20.8% in the experimental and control conditions,respectively. the incremental effectiveness was 0.35 - 0.21 = 0.15 (se 0.06,p = .01). the annualized incremental costs were -€5039 per participant. therefore,the mean incremental cost-effectiveness ratio (icer) was estimated to be -€5039/0.15 = -€34,727 after rounding (us -$41,325) for an additional treatment response,indicating annual cost savings per treatment responder. conclusions: this is the first trial to indicate that online self-help to reduce suicidal ideation is feasible,effective,and cost saving. limitations included reliance on self-report and a short timeframe (6 weeks). therefore,replication with a longer follow-up period is recommended.