• Bibtex: @denchev2018
  • Bibliography: Denchev, P., Pearson, J. L., Allen, M. H., Claassen, C. A., Currier, G. W., Zatzick, D. F., & Schoenbaum, M. (2018). Modeling the Cost-Effectiveness of Interventions to Reduce Suicide Risk Among Hospital Emergency Department Patients. Psychiatric Services, 69(1), 23–31. https://doi.org/10.1176/appi.ps.201600351

Example citation

A simulation study found that caring contacts would lead to improved outcomes and reduce costs compared with usual care after visits to the emergency department

My notes

  • They compared CC, telephone follow-up and suicide focused CBT to TAU in simulations
  • All three interventions were found to be highly cost-effective, and CC was even simulated to lead to cost savings compared to TAU.
    • CC was “dominant”, both lower costs and better outcomes
  • They use the term postdischarge suicide risk
  • Only general hospital EDs, not psychiatric EDs.

65% would receive no specific treatment after discharge, and 35% would receive an average of one initial diagnostic evaluation plus two 45-minute psychotherapy sessions during the 12 weeks postdischarge

Seems awfully low, only 35% receiving some kind of care after discharge?

Our modeled analysis of ED-initiated suicide prevention interventions found that postcards improved outcomes and reduced costs, compared with usual care.

These findings were largely insensitive to plausible variation in model inputs. In our view, this provides a compelling rationale for widespread implementation of any of these interventions, particularly postcards…



This study estimated the expected cost-effectiveness and population impact of outpatient interventions to reduce suicide risk among patients presenting to general hospital emergency departments (EDs), compared with usual care. Several such interventions have been found efficacious, but none is yet widespread, and the cost-effectiveness of population-based implementation is unknown.


Modeled cost-effectiveness analysis compared three ED-initiated suicide prevention interventions previously found to be efficacious—follow-up via postcards or caring letters, follow-up via telephone outreach, and suicide-focused cognitive-behavioral therapy (CBT)—with usual care. Primary outcomes were treatment costs, suicides, and life-years saved, evaluated over the year after the index ED visit.


Compared with usual care, adding postcards improved outcomes and reduced costs. Adding telephone outreach and suicide-focused CBT, respectively, improved outcomes at a mean incremental cost of 18,800 per life-year saved, respectively. Monte Carlo simulation (1,000 repetitions) revealed the chance of incremental cost-effectiveness to be a certainty for all three interventions, assuming societal willingness to pay ≥$50,000 per life-year. These main findings were robust to various sensitivity analyses, including conservative assumptions about effect size and incremental costs. Population impact was limited by low sensitivity of detecting ED patients’ suicide risk, and health care delivery inefficiencies.


The highly favorable cost-effectiveness found for each outpatient intervention provides a strong basis for widespread implementation of any or all of the interventions. The estimated population benefits of doing so would be enhanced by increasing the sensitivity of suicide risk detection among individuals presenting to general hospital EDs. PDF: denchev_2018_modeling_the_cost-effectiveness_of_interventions_to_reduce_suicide_risk_among.pdf