jeudi 15 février 2018

ETUDE RECHERCHE Une analyse coût-efficacité des programmes de prévention du suicide en milieu scolaire.

A cost-effectiveness analysis of school-based suicide prevention programmes.
Ahern S1, Burke LA2, McElroy B2, Corcoran P3, McMahon EM3, Keeley H4, Carli V5,6, Wasserman C5,6,7, Hoven CW7,8, Sarchiapone M9,10, Apter A11, Balazs J12,13, Banzer R14, Bobes J15, Brunner R16, Cosman D17, Haring C14,18, Kaess M16, Kahn JP19, Kereszteny A12,20, Postuvan V21, Sáiz PA15, Varnik P22, Wasserman D5,6.

1 Centre for Policy Studies, Cork University Business School, University College Cork, Cork, Ireland.
2 Cork University Business School, University College Cork, Cork, Ireland.
3 National Suicide Research Foundation, Cork, Ireland.
4 Child and Adolescent Mental Health Service, Health Service Executive, Mallow, Cork, Ireland.
5 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.
6 WHO Collaborating Centre for Training, Research and Methods Development in Suicide Prevention, Stockholm, Sweden.
7 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
8 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
9 Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
10 National Institute for Health, Migration and Poverty, Rome, Italy.
11 Schneider Children's Medical Centre of Israel, Tel-Aviv University, Tel Aviv, Israel.
12 Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
13 Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.
14 Addiction Help Services B.I.N., Anichstraße 34, Innsbruck, Austria.
15 University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
16 Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
17 Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
18 Department Psychiatry and Psychotherapy, Tirol Kliniken, Hospital Hall in Tyrol, Innsbruck, Austria.
19 Department of Psychiatry, CHRU de NANCY and Pole 6, Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France.
20 Doctoral School of Semmelweis University, Budapest, Hungary.
21 Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia.
22 Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia.

Eur Child Adolesc Psychiatry. 2018 Feb 14. doi: 10.1007/s00787-018-1120-5. [Epub ahead of print]

Suicide is one of the leading causes of death among young people globally. In light of emerging evidence supporting the effectiveness of school-based suicide prevention programmes, an analysis of cost-effectiveness is required. We aimed to conduct a full cost-effectiveness analysis (CEA) of the large pan-European school-based RCT, Saving and Empowering Young Lives in Europe (SEYLE). The health outcomes of interest were suicide attempt and severe suicidal ideation with suicide plans. Adopting a payer's perspective, three suicide prevention interventions were modelled with a Control over a 12-month time period. Incremental cost-effectiveness ratios (ICERs) indicate that the Youth Aware of Mental Health (YAM) programme has the lowest incremental cost per 1% point reduction in incident for both outcomes and per quality adjusted life year (QALY) gained versus the Control. The ICERs reported for YAM were €34.83 and €45.42 per 1% point reduction in incident suicide attempt and incident severe suicidal ideation, respectively, and a cost per QALY gained of €47,017 for suicide attempt and €48,216 for severe suicidal ideation. Cost-effectiveness acceptability curves were used to examine uncertainty in the QALY analysis, where cost-effectiveness probabilities were calculated using net monetary benefit analysis incorporating a two-stage bootstrapping technique. For suicide attempt, the probability that YAM was cost-effective at a willingness to pay of €47,000 was 39%. For severe suicidal ideation, the probability that YAM was cost-effective at a willingness to pay of €48,000 was 43%. This CEA supports YAM as the most cost-effective of the SEYLE interventions in preventing both a suicide attempt and severe suicidal ideation.Trial registration number DRKS00000214.

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