Brief CBT cost effective for suicidal Army soldiers

Brief cognitive behavioral therapy may be a cost-effective intervention for United States Army soldiers who are at risk for suicide, according to results of an economic evaluation published in JAMA Psychiatry.

“In response to increasing suicides in the U.S. military, the U.S. Department of Defense (DoD) has prioritized suicide prevention, implementing many different preventive interventions,” Samantha L. Bernecker, PhD, of the department of health care policy at Harvard Medical School, and colleagues wrote. “The cost-effectiveness of these interventions has not been systematically assessed; in most cases, the comparative efficacy of the interventions used in military service members remains unknown.”

According to the researchers, brief CBT is a suicide-focused intervention spread over 12 sessions that can accommodate the unpredictability of military because of its flexibility and brevity. They evaluated brief CBT’s cost-effectiveness compared with treatment as usual for suicidal soldiers in the U.S. Army.

Bernecker and colleagues obtained demographic data from the Army Study to Assess Risk and Resilience in Service Members, and a trial that randomly assigned 152 Army soldiers with recent suicidal crises to either treatment as usual of brief CBT plus treatment as usual. Using a decision analytic model that compared costs and effects of brief CBT vs. treatment as usual from a U.S. DoD perspective, they found that brief CBT was expected to prevent approximately 23 to 25 more suicide attempts and one to three more suicide deaths per 100 patients treated than treatment as usual. In most scenarios, brief CBT was cost-saving based on sensitivity analyses that assumed a range of treatment effects. The researchers used the federal discount rate and estimated that the DoD could save between $15,000 and $16,630 per patient with brief CBT vs. treatment as usual. They noted that assuming the weakest plausible brief CBT effect sizes, the intervention could cost an additional $1,910 to $2,250 per patient compared with treatment as usual.

“If the DoD disseminates [brief] CBT for service members with recent suicidal crises, it will be critical to work with dissemination and implementation experts to ensure treatment fidelity through effective and efficient training,” the researchers wrote. “To bolster confidence in [brief] CBT’s effectiveness, the DoD can await results of an ongoing trial, but sensitivity analyses suggest that [brief] CBT will remain cost saving even if its effects are weaker than predicted.” – by Joe Gramigna

Disclosures: Bernecker reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.