Table 1.

Inputs

Category	Point estimate	Range	Source
PREVALENCE
Suicide risk status at time of initial ED presentation
High risk	2.8%		*
Low risk	9.6%		*
No risk	87.6%		*
Triage
Medical Branch	93%	90% – 97%	*
Percentage of the hospitalized patients among the general ED population (i.e., the study cohort)	13.4%	12.2%–14.6%	38,39,**
Of these, hospitalized for medical reasons, no sign of suicidality	7.04%*		*
Of these, no risk	100%	100% – 100%	*
Of these, hospitalized for medical reasons, apparent self-injury	4.5%	2% – 8%	**
Of these, high risk	20%	15% – 25%	**
Of these, low risk	30%	25% – 35%	**
Of these, no risk	50%**		*
Of these, medical treatment in ED	88.46%		*
Of these, high risk	1.75%	0.75% – 2.75%	40,***
Of these, low risk	8%	6% – 10%	27,40,***
Of these, no risk	90.25%	87.25% – 93.25%	30,***
Psych Branch	7%	3% – 10%	41
Of these, high risk	7.5%	5% – 10%	41,***
Of these, low risk	25%	20% – 30%	41,***
Of these, no risk	67.5%	60% – 75%	30,***
SENSITIVITY & SPECIFICITY
Medical Branch, suicide screening
Sensitivity, high risk	30%	20%–40%	**
Sensitivity, low risk	3%	0% – 6%	**
Specificity, no risk	99%	95% – 100%	**
Medical Branch, suicide risk assessment among those with positive suicide screening
Sensitivity, high risk	95%	90% – 100%	**
Sensitivity, low risk	66%	50% –80%	**
Specificity, no risk	50%	40% – 60%	**
Psych Branch, suicide risk assessment (100% assumed to have positive suicide screening)
Sensitivity, high risk	95%	93%–97%	**
Sensitivity, low risk	66%	50%–80%	**
Specificity, no risk	56%	46% – 66%	42
Sensitivity & specificity of identifying suicide risk in patients admitted to hospital from ED for medical reasons
Sensitivity, high risk	100%	100% – 100%	**
Sensitivity, low risk	100%	100% – 100%	**
Specificity, no risk	50%	40% – 60%	**
EVENT PROBABILITIES – PSYCHIATRIC HOSPITALIZATION
Medical Branch, positive suicide screen & positive suicide assessment	35%*	25% – 45%	24,***
Psych Branch, positive suicide assessment	80%	70% – 90%	24,***
Psych Branch, negative suicide assessment	10%	5% – 15%	**
BASE COSTS
Medical ED visit (no risk; discharged alive)	$675	$25–$2,850	24,***
Medical ED visit (high risk or low risk; discharged alive)	$890	$25–$3,350	24,***
Psych ED visit (discharged alive)	$695	$25–$2,950	24,***
Suicide risk assessment	$150	$100–$200	**
Medical hospitalization (no risk; discharged alive)	$8,765	$1,450–$33,500	24,***
Medical hospitalization (no risk; died in the hospital)	$21,740	$1,650 – $104,000	24,***
Medical hospitalization (high risk or low risk; discharged alive)	$11,080	$1,550–$49,500	24,***
Medical hospitalization (high risk or low risk; died in the hospital)	$21,460	$2,650–$123,000	24,***
Psychiatric hospitalization (discharged alive)	$5,875	$1,050–$20,500	24,***
Psychiatric hospitalization (died in the hospital by suicide)	$18,790	$1,350–$85,000	24,***
Inpatient suicide Tx	$2,000		**
DEATH AND REATTEMPT RATES
Death by non-suicide manner (in 6 weeks) – same for all risk categories & treatments: Based on average non-suicide mortality for ages 35–44, US, general population, men & women combined, 2007–2010	0.02044%		43
Probability for a new suicide attempt (assuming no treatment)
High risk –1st Markov cycle after the index event	0.048		44,***
High risk – 2nd – 4th Markov cycle, each	0.00038		44,**
High risk – 5th Markov cycle	0.00029		44,**
High risk – 6th – 9th Markov cycle, each	0.00020		44,**
Low risk – no treatment (false negative) – distributed by 6-week cycles	50% of high rate		**
No risk	0%		**
Ratio of suicides to suicide attempts	1:13		45,46
Years of Potential Life Lost per suicide	24		46,***
INTERVENTIONS - UPTAKE, OUTCOMES and COSTS
Usual Care (UC; also provided to people who receive inpatient suicide treatment)***
Uptake (i.e., this % receive any outpatient suicide treatment)	35%	10% – 50%	**
Reduction in (re-)attempt rate, vs. no treatment	15%	10% – 20%	**
Cost [based on CPT 90791 (psychiatric diagnostic evaluation) + 2 times CPT 90834 (45 min psychotherapy)]	$340		23,**
Postcards (PC)*
Uptake	100%	NA	11
Reduction in (re-)attempt rate, vs. UC	45%	35% – 55%	11,**
Additional cost of intervention [based on $10 per person for the postcards per se; plus $135 (1.5 CPT 90834 visits) in additional outpatient treatment as function of receiving the postcards]	$145	$135 – $500	11,**
Telephone Outreach (TO)
Uptake (i.e., this % of those offered TO participate; the rest do UC only)	70%	60% – 80%	12,**
Reduction in (re-)attempt rate among those with TO uptake, vs. UC	34%	25% – 45%	12,**
Additional cost of intervention, for those with uptake [based on $30 for the phone calls per se, plus $270 (3 CPT 90834 visits) in additional outpatient Tx as function of receiving the calls]	$300	$300 – $900	12,**
Cognitive Behavioral Therapy (CBT)
Uptake (i.e., this % of those offered CBT participate; the rest do UC only)	65%	55% – 75%	13,**
Reduction in (re-)attempt rate among those with uptake, vs. UC	50%	40% – 60%	13,**
Additional cost of intervention, for those with uptake [based on 9 times CPT 90834]	$810	$810 – $2000	13,***

NOTES:

^*Calculated by the authors based on available data regarding prevalence of suicide risk within subgroups of the ED population (i.e., the sources cited under “Triage” in Table 1), so that each individual presenting to the ED for the initial (index) visit is counted exactly once

^**Author opinion

^***Author opinion, considering information available from the listed source(s)