Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia

Abstract

IMPORTANCEInstallation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. OBJECTIVE To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. INTERVENTIONS Barriers installed at bridge and cliff sites. MAIN OUTCOMES AND MEASURES Primary outcome was return on investment (ROI) comparingcost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers.

Perspectives on reasons for suicidal behaviour and recommendations for suicide prevention in Kenya: qualitative study

“… 50 Structural changes to bridges to restrict access have been found to be effective in some studies. 51 Regardless of the means restriction strategy identified, of importance is that the method identified is a high contributor to suicide in the area; the suitability of means restriction and elimination of the method should then be considered, as well as the social impact of placing such restrictions. 52 …”

Social Media Sentiments on Suicides at the New York City Landmark, Vessel: A Twitter Study

“…In our sampled tweets, although a few people complained about the closure of Vessel due to the suicide incidents and expressed their wish to visit it in the future (Theme 3) , no one argued against the installation of barriers for aesthetic reasons; in fact, this was the second most popular suggestion, closely following the demand for dismantling the structure in the fourth case. Regarding the economic argument surrounding raising barriers, although the price is indisputably high, studies have shown that the return on investment often outweighs its cost [ 51 , 52 ]. Erecting barriers is proven to be a highly cost-effective and warranted suicide prevention strategy that is well recognized by the public.…”

Rethinking Suicide Prevention as a Public Health Issue

“…It is time to integrate these clinical approaches into the conceptual framework for self-injury prevention grounded on the Haddon matrix. The costeffectiveness of installing physical barriers in bridges and cliffs to reduce suicides in these hotspots, as reported by Bandara and colleagues, 4 is especially instructive for developing and implementing engineering-and technology-based strategies aimed at environmental factors and major vectors carrying the etiologic agent, such as firearms and drugs, to reduce self-injury rates in the US.…”

“…The stagnation in suicide prevention is not for lack of trying . In light of the ongoing COVID-19 pandemic, the worsening opioid crisis, and the rising prevalence of depression and other mental health problems, the study by Bandara and colleagues offers a glimmer of hope and a window of opportunity for rethinking suicide prevention.…”

“…The Bandara et al study provides valuable evidence for addressing the second concern about hotspot-based interventions to reduce suicides. Using standard health economics methods, the authors estimated the costs saved and the return on investment associated with the installation of physical barriers at 26 bridge and cliff sites identified as suicide hotspots in Australia.…”