The Cost of Suicide to Society

The Cost of Suicide in
New Zealand
Introduction
This paper provides a monetary value on the cost of suicide to New Zealand, by:

considering the usefulness of ‘cost of suicide’ calculations to policy development

providing an update of the cost of suicide, building on an earlier report by Des O’Dea and
Sarah Tucker (2005) The Cost of Suicide to Society

critiquing the methodology of cost of suicide calculations

providing examples of how cost of suicide calculations have been used to inform the analysis
and development of international suicide prevention initiatives.
Background
The cost of suicide is based on an analysis of the costs arising from suicides and intentional selfharm incidents.
Number and rates of suicide
A total of 508 people died by suicide in New Zealand in 2013 (365 were male and 143 female).1
This equates to an age-standardised rate of 11.0 deaths per 100,000 population. Between 2004
and 2013, suicide rates have ranged from 10.9 to 12.2 deaths per 100,000.
1
The most recent year for which full data is available.
The cost of suicide in New Zealand
1
Figure 1: Numbers and rates of suicide, 2004–2013
Intentional self-harm hospitalisations in 2013
In 2012 there were 7267 intentional self-harm hospitalisations. Seventy percent of these were
female.
The data below shows a significant increase in self-harm hospitalisations in 2013. However the
data is not comparable due to a change in reporting methodology in 2013. Before 2013 self-harm
hospitalisations generally only included those who were admitted to hospital (ie, excluding
those treated in emergency departments only). In 2013, the self-harm hospitalisation data
includes not only those who were admitted to hospital but also those who were seen in an
emergency department.
Table 1: Intentional self-harm hospitalisation numbers, by sex, 2003–2013
Year
Male
Female
Total
2003
1,048
2,093
3,141
2004
982
2,018
3,000
2005
953
1,790
2,743
2006
991
1,878
2,869
2007
940
1,746
2,686
2008
877
1,591
2,468
2009
947
1,592
2,539
2010
990
1,835
2,825
2011
940
1,708
2,648
2012
1,011
2,020
3,031
2013
2,225
5,042
7,267
Source: New Zealand National Minimum Dataset
2
The cost of suicide in New Zealand
Valuing the ‘cost of suicide’ to
New Zealand
Studies on the costs of injury such as suicide have been around for a number of years. Such
studies are used to inform resource allocation decisions.
For policy purposes, the calculation of suicide costs puts a monetary value on these events. This
value can be used to compare costs of suicide and self-harm hospitalisations, and assess the
relative benefits of proposed investments.
The government has finite resources for investment across a range of areas, which drives the
need to make trade-offs between spending priorities. The factors that influence decision making
include: evidence of the intervention’s effectiveness; the estimated benefits that will be
achieved; and the cost of interventions.
There are many reasons for investing in suicide prevention, including the humanitarian desire
to prevent pain and suffering, and moral imperatives about preventing loss of life. Economic
analysis of the ‘cost of suicide’ attempts to place values on these non-economic factors, but
because they are intangible or value driven, placing a monetary value on these can be difficult.
The ‘Cost of Suicide’ calculations carried out in this report can be used alongside evidence of
what interventions work, to help illustrate the estimated ‘return on investment’ of prospective
investments in suicide prevention activities.
Update of ‘Cost of Suicide’
The most recent review of the economic costs of suicide in New Zealand was done by O’Dea and
Tucker (2005) Cost of suicide to society. They estimated that the total economic and
non-economic cost from suicides and attempted suicides was $1,381 million.
The 2005 analysis of economic costs is based on 460 suicides and 5,095 attempted suicides in
2002.This update uses 2013 data, which is the most recent available data. In 2013 there were
508 suicides and 7,267 intentional self-harm hospitalisations.
Costing methodology used to calculate ‘Cost of
Suicide’ in New Zealand
Costs outlined in this report are classified as broadly:

Economic costs
– Costs excluding lost production – these are the direct costs of a suicide or self- harm
hospitalisation. They include the cost of a funeral, ambulance and police involvement, the
coronial process and victim support.
– Cost of lost production – these are indirect costs associated with the loss of a person from
the current or future workforce. These are a measure of the opportunity costs in the form
of forgone benefits borne by society.
The cost of suicide in New Zealand
3

Non-economic costs
The non-economic costs of a suicide death or self-harm attempt include psychological
distress, impaired physical or mental health, pain and suffering, and loss of employment and
quality of life. They reflect the loss of life years and disability-free life years. These costs are
often subjective and very difficult to quantify because people place different values on these
costs. In New Zealand, one mechanism that puts a monetary value on these non-economic
costs is the ‘Value of a Statistical Life’ (VOSL). The VOSL was $3.85 million per fatality at
June 2013 prices.2 While the VOSL is updated on a yearly basis, we have used the June 2013
VOSL as the most recent suicide data is from 2013.
This update of the cost of suicide has attempted to use the costing methodology and base
information obtained by O’Dea and Tucker as a starting point. We have not done an extensive
review of all the cost inputs and assumptions that were used in the 2005 analysis. Instead, we
have adjusted cost of services to 2015 real values using a CPI inflation multiplier. The noneconomic costs are calculated using the O’Dea and Tucker values as a base, with a multiplier
applied to these values to reflect movement in the value of a life since 2004.
Table 2: Economic cost of suicides
Suicides
Costs excluding lost production
2002
2013
$4,694,000
$6,635,496
Costs of lost production
$201,498,000
$244,250,972
Total
$206,192,000
$250,886,468
$448,250
$493,871
Cost per suicide
Table 3: Economic cost of attempted suicides
Attempted suicides
2002
2013
Costs excluding lost production
$19,092,000
$34,852,532
Costs of lost production
$13,247,000
$21,801,000
Total
$32,339,000
$56,653,532
$6,350
$7,796
Cost per suicide attempt
Note: from 2013 onwards attempted suicides included both the self-harm admissions to an emergency department
and hospitalisations. In 2012 and earlier years attempted suicide data was based on those admitted beyond
emergency departments to hospitals.
Table 4: Overall economic costs
Overall economic costs
(suicide + suicide attempts)
2002
2013
$238,531,000
$307,540,000
Table 5: Non-economic costs
2002
Value of years of disability-free life lost
Cost per suicide
2
4
2013
$1,142,400,000
$1,638,000,000
$2,483,000
$3,224,409
The VOSL comes from the Ministry of Transport (2014) Social Cost of Road Crashes and Injuries 2014 update.
The cost of suicide in New Zealand
Table 6: Total costs of suicide
2002
Economic costs
2013
$238,531,000
$307,540,000
Non-economic costs
$1,142,400,000
$1,638,000,000
Total cost
$1,381,492,000
$1,945,540,000
The costings above are based on a number of assumptions (outlined in Annex A). A detailed
breakdown of how the economic costs and the non-economic costs are calculated is provided in
Annex B and C.
While the calculations are not as precise as those of O’Dea and Tucker (2005), and the cost
fluctuates markedly from year to year with the rate of suicide and self-harm attempts, the cost is
broadly around $2.0 billion per annum (if incidence of suicide and attempts remain near 2013
figures).
Methodological issues with ‘cost of
suicide’ calculations
There are some difficulties in expressing the cost of suicide in monetary terms.
Issues with data collection and measurement
While the services associated with suicide can generally be identified, there are issues around
how to measure the cost of these services. For instance, should the costs just be the marginal
costs of services responding to a suicide (eg, police, ambulance) or should it include an
allowance for overhead costs such as salaries, depreciation, capital costs. The costings in this
report use the marginal costs of these services.
Calculations of cost of lost production
There are also issues around how to best measure the cost of lost production. One approach
used in this report (and by O’Dea and Tucker) is to use the average market income at different
age groups of people who die from suicide. These values are expressed in present value terms,
discounted over what would have been their expected remaining life if they had not died from
suicide. This can determine a lifetime’s lost earnings. This measure of a lifetime’s lost earnings is
used to estimate lost production values. For suicide attempts, O’Dea and Tucker used self-harm
data and assumed that people would be off work for a period of time. Allowances were also
made for disruptions to work for family and friends of the person.
Determining values for non-economic costs
Non-economic costs reflect the costs of pain and suffering that are incurred as a result of a
suicide or suicide attempt. These non-economic values attempt to quantify how much society is
willing to pay to avoid this pain and suffering.
The cost of suicide in New Zealand
5
Disability Adjusted Life Years (DALYs) provide a mechanism of quantifying the impact of
suicide in terms of disability adjusted life years. O’Dea and Tucker (2005) then take the DALYs
and express these DALYs in monetary terms using the VOSL.
The methodology used for non-economic costs assumes that all life years lost are of equal value.
This is despite the fact there is some evidence, including by O’Dea (2004) that this is not correct.
However it would be impractical to try to place different values on people who have lost their life.
The costing methodology used by O’Dea and Tucker (2005) also included placing a value on the
DALY for suicide at different age groups. The DALYs calculated provide a measure of changes in
expected longevity weighted by an index of disability or impairment, which incorporates an age
weighting to life years at different ages (to distinguish condition-specific disability from
age-related impairment).
The VOSL calculations are not without critics. As noted by Guria (2010) trying to place a value
on a life is difficult. Medical treatment costs or the value of lost production are relatively easy to
count. But as Guria notes, it is both contentious and difficult to put a monetary value on the
worth of avoiding a premature death or disability.
The VOSL is also an estimate based on what people were prepared to pay for a reduction of a
specific risk. While it is tempting to use the road transport VOSL and apply it elsewhere (as done
by O’Dea and Tucker) a big question arises as to whether this is appropriate for other types of
risk. There is evidence that what people are prepared to pay for a risk reduction may differ by
the type of risk. For instance, the Health and Safety Executive in the UK recommends use of a
higher VOSL for prevention of a cancer death than the transport VOSL, to take into account ‘the
protracted period of pain and suffering’ associated with the disease.
Suicide could in some situations be a ‘cost saving’
There can also be significant difficulties in estimating long-term costs, such as a disability
incurred that may have resulted from a suicide attempt. There are also situations where suicides
could result in some savings.
While any suicide is a tragedy, there could be situations where a suicide could represent a cost
saving. Lester and Yang (2010) argue that suicides may, in fact, provide an economic benefit to
our nation. Premature deaths would certainly help us avoid expenditure on medical conditions
or other areas of expenditure such as pensions, and nursing home care.
Lester and Yang (2010) argue that many of those who die from suicide are often marginal
members of society, and the loss of income is not as great as other scholars assume. The deaths
of individuals suffering from depression eliminates the need for treatment of these individuals
in later years. Those aged over 65 who die from suicide mean that the state does not have to pay
national superannuation costs. When prisoners or criminals die, the state does not have to fund
the costs of the criminal justice system for these individuals.
At present the data does not allow for an adjustment for circumstances in which a suicide could
result in offset financial costs to the government or to private individuals. Information on those
who die from suicide does not record at an aggregate level whether the deceased person had
long standing medical conditions, or other factors such as whether the person was in custodial
care within the criminal justice system.
6
The cost of suicide in New Zealand
How investments in suicide prevention
programmes have generated
significant economic savings
The economic savings from suicides averted has been used as an input to justify investment in
suicide prevention in a number of countries. The economic argument is not the only reason for
such investments, as the significant impact of suicide on individuals and society (including lives
saved and emotional trauma and grief avoided) is also significant.
Studies that have looked into the economic benefits, relative to the costs of suicide prevention,
have included:

Scotland – the evaluation by Platt et al (2006) of Choose Life, Scotland’s national suicide
prevention strategy concluded that a net cost saving would be achieved if five additional lives
were saved each year. Scotland invested an additional £12 million over three years 2003 to
2006. The Scottish Government (2015) has reported a 17 percent reduction in suicide over
10 years between 2000-2004 and 2010–2014.

Florida – an evaluation by Sari et al (2008) of two Florida prevention programmes, general
suicide education and peer support programmes that were provided for college students
achieved significant economic savings that were greater than the costs of the programme. The
programme cost US$17.9 million for a general suicide education program and
US$10.09 million for a peer support program. The calculated results are heavily influenced
by the discount rate used and the attribution of results to the programmes, but estimated the
programmes achieved net benefits of between US$112 million and US$109 million.

Ireland – it was estimated by Kennelly (2007) that the economic cost of suicide in Ireland is
estimated at over €906 million in 2001, and over €835 million in 2002 (in 2001 prices). This
is equivalent to a little under 1 percent of the gross national product in Ireland for those
years. Kennelly concluded that the results show that investment in health education and
health promotion can be justified on the basis of the costs associated with suicide in Ireland.
Conclusion
The calculations of the economic return from investments in suicide prevention are highly
impacted by the assumptions and methodology used for calculating the costs and benefits.
Regardless of the methodology and assumptions there is a sufficient economic case for
investments in suicide prevention. These investments still need to be supported by evidence of
effectiveness.
There is a need to be mindful that some individual situations will mean that not all investments
that result in lives saved will equate to a net economic benefit. However these situations are the
exception to the majority of persons who attempt suicide or die from suicide. There is still a
moral imperative for investment to prevent suicide among these individuals.
The cost of suicide in New Zealand
7
Bibliography
Centre for Suicide Prevention. 2010. The Cost of Suicide SIEC Alert#74, June.
Chisholm D, et al. 2016 Scaling-up treatment of depression and anxiety: a global return on
investment analysis. The Lancet 3(5), May 2–16, pp 415–26.
Clough P, Guria J, Bealing M. 2015. Approaches to Valuing Injury and Mortality Risk in Transport
Assessments. NZ Transport Agency research report 571.
Guria J. 2010. Fix flawed values of statistical life and life years to get better policy outcomes. Insight,
NZIER.
Kennelly B, 2007. The economic cost of suicide in Ireland. Crisis 28: pp 89–94.
Ministry of Transport. 2013. Social Cost of Road Crashes and Injuries 2013 update.
O’Dea. 2004. Who should have health-care priority? Community preferences shown by ‘ad hoc’
surveys. Seminar, Wellington School of Medicine, 29 October.
O’Dea D, Tucker S. 2005. The Cost of Suicide to Society. Wellington: Ministry of Health.
Platt S, et al. 2006. Evaluation of the first phase of Choose Life: the National Strategy and Action
Plan to Prevent Suicide in Scotland.
Rutz W, Carlsson P, von Knorring L, et al. 1992. Cost-benefit analysis of an educational program for
general practitioners by the Swedish Committee for the Prevention and Treatment of Depression.
Acta Psychiatrica Scandinavica 85: 457–64.
Sari N, de Castro S, Newman FL, et al. 2008. Should we invest in suicide prevention programs? The
Journal of Socio-Economics 37: 262–75.
Scottish Government. 2015. Reduction in Suicide – rate reduces 17% in 10 years
http://scottishgovernment.presscentre.com/News/Reduction-in-suicide-1c20.aspx
Shepard D, et al. 2015. Suicide and suicidal attempts in the United States: costs and policy
implications. Suicide and Life Threatening Behaviour 10.1111/sltb.12225.
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Initiatives, September.
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Allocation: A background briefing paper to inform the evaluation of the New Zealand Injury
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Yang B, Lester D. 2010. Is there an economic argument for suicide prevention? A response to
Doessel and Williams Suicidology Online 1: 88–91.
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The cost of suicide in New Zealand
Annex A: Assumptions
The economic costs based on 2013 suicide and self-harm attempts are in 2015 dollars and are
based on the cost of services that were revealed by O’Dea and Tucker (2005) with the Reserve
Bank inflation multiplier applied to the 2002 costings. While O’Dea and Tucker went back and
contacted various services such as ambulance, police, emergency departments to determine the
2002 costings, this has not been done for this update exercise, instead the 2002 costs were used
with an inflation multiplier applied.
Attempted suicide data is based on self- harm hospitalisations data from 2012 (which is the
most recent data available).This data is incomplete as there is an unknown number of attempted
suicides that do not result in hospitalisation. There is a risk that the self-harm costs are
unreported in the costing analysis.
It is also worth noting that not all those who have had a self-harm hospitalisation intended to
die from their self-harm activity and as such this should not be counted in the cost of suicide
calculations. However, as self-harm hospitalisation data is used as a proxy for the number of
suicide attempts, self-harm costs are overstated in this regards.
The calculation of the non-economic costs uses the June 2013 value of a statistical life of
$3.85 million. This VOSL was calculated by the Ministry of Transport. While there are later
updates in the VOSL (at higher levels), the June 2013 value is used due to the suicide death data
being from 2013.
The VOSL is applied to suicide deaths only. Due to gaps in data we are unable to apply VOSL to
self-harm attempts that require hospitalisation. Some of those who have self-harmed will have
ongoing permanent injuries as a result of their suicide attempt. The result is a risk that the selfharm costs are unreported in the costing analysis.
The costings by O’Dea and Tucker (2005) made the following assumptions about the costs of
short term absences from work. To convert these costings into 2015 dollars, a multiplier of 1.15
was used (based on movement of the Statistics NZ index for ‘Real gross national disposable
income per person’ between 2004 and 2015).
Table 7: Estimated costs of absence from work due to suicide or attempted suicide
Estimated cost (nominal
– 2005)
Estimated cost
(real – 2015)
A person attempting suicide off work for 10 days
$1300
$1500
Two family members etc of a person who attempted
suicide off work for five days each
$1300
$1500
Family, friends of person who died from suicide – loss of
20 working days across all friends and family
$2600
$3000
It should be noted that these costings do not allow for longer periods of time spent off work, or
less productivity that could occur on an ongoing basis as a result of a person having a long term
disability resulting from a suicide attempt.
The calculations used by O’Dea and Tucker (2005) used a range of discount rates to
demonstrate the sensitivity of changes in levels of discount rates on the findings. The findings
are summarised in their report. The discount rate that is used to present the cost of 2002
suicides was the 8 percent discount rate which is the rate most often used New Zealand
government agencies.
The cost of suicide in New Zealand
9
Annex B: Economic costs of suicide
O’Dea and Tucker (2005) did an extensive analysis of the direct costs of a suicide or self-harm
hospitalisation. They also provided an estimate of the Cost of lost production due to the loss of a
person from the current or future workforce. These are a measure of the opportunity costs in the
form of forgone benefits borne by society.
An inflation multiplier has been used to update the costs in the following tables.
Direct costs of a suicide
The following table outlines the direct economic costs of a suicide. These costs are the costs of
providing services as a result of a suicide death. In 2013 there were 508 suicides at a cost of
$13,062 which resulted in total direct services costs of $6,635,496.
Table 8: Economic costs per suicide, excluding lost production 3
Service
Unit of measurement
Police
Suicide attendance
Victim support
$1,608
$842.67
$1,079
$100
$128
Burial (30% of deaths)
$1,950
$8,320
Cremation (70% of deaths)
$3,500
$6,400
Reception
$650
$832
Contact
$264
$338
$33.28
$42.60
negligible
negligible
$1,100
$1,408
$500
$640
$10,205
$13,062
Transport to morgue
Travel
Coroner
Cost per suicide (GST
exclusive) mid-2015
estimate5
$1,256.98
Mortuary/inquest attendance
Funeral directors
Cost per suicide (GST
exclusive) mid-2004
estimate4
Forensic
Post-mortem
Inquest
Total
3
There are some costs of suicide that are not included above due to difficulty in calculating these costs. These costs
include the costs of paramedic attendance at a suicide attempt where the person subsequently dies. In some
situations there could be subsequent costs to hospitals (emergency department costs, and intensive care unit
costs), prior to the subsequent death. As we do not have data on the number of suicide attempts that resulted in
typically short term medical attention by paramedics and hospital staff, these costs are not included in the
costings above.
4
The costs of individual components in 2004 were determined following research by O’Dea and Tucker (2005).
5
The mid 2015 cost estimates are based on the cost components identified by O’Dea and Tucker expressed in 2015
dollars. A rate of 1.28 from the Reserve Bank inflation calculator was used to update the cost estimates from 2004
to 2015.
10
The cost of suicide in New Zealand
Direct costs of a suicide attempt
Table 9: Direct costs of suicide attempts
Service
Unit of measurement
Police
Attempted suicide
$400.97
$513.24
Mental health crisis response
team
Attempted suicide
$100.00
$128.00
Ambulance
Ambulance attendance
$383.27
$490.59
Emergency Department
Admission
$250
$320.00
Hospital health care
Discharge
$2,513.00
$3,216.64
Victim Support
Attempted suicide
$100.00
$128.00
$3,747.24
$4,796.47
Total
Cost per suicide
attempt (GST excl)
mid-2004 estimate4
Cost per suicide
attempt (GST excl)
mid-2015 estimate5
In 2013 there were 7267 attempted suicides at a cost of $4,796 per attempt, resulting in total
direct costs of $34,852,532.
The 2013 self-harm data includes those who received medical attention at the emergency
department and discharged, and also those who were admitted to hospital. The data in previous
years was based only those who were admitted to hospital. Therefore 2013 data should not be
compared with previous years. We have used 2013 self-harm data as it is a more accurate
reflection of those who had made self-harm attempts.
Lost production values
The approach used by O’Dea and Tucker was to use a measure of the lost gross earnings. Where
there has been an attempted suicide, a costing is used based on average hourly earnings for
different age groups, for the short term absence from the workplace.
For those who have died from suicide the average market income at different age groups, over
their expected remaining life, is used to determine a lifetime’s lost earnings. This measure of a
lifetime’s lost earnings is used to estimate lost production values.
The cost of suicide in New Zealand
11
Table 10: Average market incomes by age group, June quarter 2013
Age group
(years)
Yearly average market income
($)
15–19
6,396
20–24
22,620
25–29
35,828
30–34
43,472
35–39
49,556
40–44
53,144
45–49
52,780
50–54
49,868
55–59
47,008
60–64
37,648
65+
8,580
Source: NZ Income Survey June 2013 quarter
The information above is used below to calculate discounted lost future market income for
different age groups. The first line assumes no productivity growth each year. The second line
allows for a 1 percent productivity gain each year.
Table 11: Lost lifetime market income per suicide, averaged over all ages
Discount rate
3%
5%
6%
7%
8%
Assuming average June 2013 market income and
no productivity gain
$784.5
$598.1
$531.6
$477.4
$432.6
Assuming average June 2013 market income and
1% per annum productivity gain
$920.5
$684.3
$601.7
$535.2
$480.8
Short spells off work
The following assumptions, which were also used by O’Dea and Tucker (2005) are made about
the costs related to short absences from work.
Table 12: Estimated costs of absence from work due to suicide or attempted suicide
Estimated cost (nominal – 2005)
A person attempting suicide off work for 10 days
$1300
Two family members etc of a person who attempted suicide off work for
five days each
$1300
Family, friends of person who died from suicide – loss of 20 working days
across all friends and family
$2600
12
The cost of suicide in New Zealand
Table 13: Lost production estimates from suicides and attempted suicides
Lost production estimates for 2002
Lost production cost estimates for 2013
Suicides
460 suicides x $438,000 per suicide
(8% discount rate)
Impact on Family, Friends lost
production 460 x $2,600
$201,498,000
508 suicides x $480,809 per suicide
(8% discount rate)
$244,250,972
$1,196,000
Impact on Family, Friends lost
production 508 x $3,000
$1,524,000
7267 self-harm hospitalisations at
$1300
$9,447,100
7267 self-harm hospitalisations at
$1500
$10,900,500
Impact on Family Friends lost
production at $1300
$9,447,100
Impact on Family, Friends lost
production at $1500
$10,900,500
Attempted suicides
Summary of all economic costs for 2013 suicide
and suicide attempts
The estimated economic costs for 2013 of 508 suicides and 7267 suicide attempts in 2015
dollars, GST exclusive are as follows:
Table 14: Economic costs for 2014 suicide and suicide attempts
Suicides
Costs excluding lost production
$6,635,496
Cost of lost production
$244,250,972
Total costs suicides
$250,886,468
Attempted suicides
Costs excluding lost production
$34,852,532
Cost of lost production
$21,801,000
Total costs attempted suicides
$56,653,532
Total
$307,540,000
The cost of suicide in New Zealand
13
Annex C: Non-economic costs of
suicide
O’Dea and Tucker (2005) calculated non-economic cost of suicide as $1,150,000,000. The noneconomic cost per suicide was calculated at $2,500,000 per suicide.
Since 2002 there has been a 29 percent growth in the VOSL, from $2,725,000 in 2002 to
$3,850,000 in 2013.
In 2012, the average age of those who die from suicide was 35.6 years, and they had an average
life expectancy of a further 44.2 years. In 2013, the average age of those who die from suicide
was 38 years and they had an average life expectancy of a further 43.5 years.
In 2002, 460 died from suicide. In 2013, 508 died from suicide.
Allowing for 29 percent growth in VOSL over the years, inflating $2.5 million cost of suicide
each year by 29 percent provides a $3.225 million cost per suicide in 2013. With 508 suicides,
the non-economic cost is estimated to be $1,628 million.
HP6587
April 2017
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The cost of suicide in New Zealand