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Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 25, Issue 4, 2022. Pages: 123-131
Published Online: 1 December 2022

Copyright © 2022 ICMPE.


Economic Evaluation of Dialectical Behavioral Therapy Versus Cognitive Behavioral Therapy for Suicide Prevention

Jessica Acolin

Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA


* Correspondence to: Jessica Acolin, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.
Tel.: +1-267-312 9466
E-mail: \underlinejyacolin@uw.edu

Source of Funding: Research reported in this publication was supported by the Agency for Healthcare Research and Quality (grant number T32HS013853, to the University of Washington). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.



Suicide is a leading cause of death for adults aged 18-64 in the United States, and suicide risk is highest among those with previous attempts. Two evidence-based treatments for suicide prevention exist: dialectical behavioral therapy (DBT), a year-long intensive treatment, and cognitive behavioral therapy (CBT), a brief (10-12 session) treatment. To our knowledge, no direct comparison of the two treatments yet exists.

Aims: To analyze the cost-effectiveness of DBT compared to CBT, in terms of both cost and quality of life, for the prevention of future suicide attempt among previous attempters.

Methods: A Markov Model was developed to estimate the incremental cost-effectiveness ratio (ICER) in 2022 US dollars per quality-adjusted life-year (QALY). Published literature was reviewed to identify parameter estimates. The target population was US adults aged 18-64 with a previous suicide attempt. A time horizon of one year was used, and costs were calculated from the health care system perspective.

Results: Compared to CBT, DBT is associated with an estimated incremental cost of $26,362 per QALY gained. One-way sensitivity analysis (OWSA) revealed consistent results, with DBT being cost-effective in most cases at a maximum threshold of $50,000 per QALY.

Discussion: Results suggest that, compared to CBT, DBT is associated with comparable costs and mortality but higher quality of life. Due to the limited evidence base, caution is recommended when interpreting and generalizing results.

Implications for Health Care Provision and Use: Given comparable cost and efficacy, patient preference for CBT or DBT must be incorporated in treatment selection. Ensuring patients play an active role in treatment selection has the potential to lead to improved clinical and health system outcomes.

Implications for Health Policies: As manualized treatments, both DBT and CBT are appropriate for trained master's level clinicians to deliver. Allowing master's level clinicians to provide evidence-based care for suicide prevention may be a cost-effective strategy for quality service provision.

Implications for Future Research: Future research grounded in conceptual theories of suicide that distinguish suicide risk from more general psychiatric risks are needed.

Received 29 January 2022; accepted 31 October 2022

Copyright 2022 ICMPE