Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study

Abstract

BackgroundThe UK has one of the highest rates for deaths from fire and flames in children aged 0–14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of ‘functioning’ smoke alarms and consequently for the prevention of fire-related injuries in children in the UK.MethodsWe carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection.ResultsEducation and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household.ConclusionsAssessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.

AHRQ series on complex intervention systematic reviews—paper 5: advanced analytic methods

“…A decision model allows the user to bring together evidence from diverse sources, to explore novel combinations of interventions, and to evaluate the gaps in the evidence and needs for further data. Through sensitivity analysis (systematically varying the value of specific parameters, either across a range defined by the literature or expert opinion, or stochastically using distributions obtained from the available evidence), the impact of uncertainty in probabilities can be illustrated, and the relative contributions of specific aspects of uncertainty can be identified [22]. This, in turn, can be very useful for identifying future research needs [39e41].…”

“…Another method under development for exploring heterogeneity is qualitative comparative analysis [18,19]. Used within a systematic review context, each individual study within the review represents a case, and qualitative comparative analysis is used to identify the combinations of intervention components, implementation features, or contextual Decision analysis [22] characteristics (e.g., population, setting, etc.) that are associated with effectiveness of an intervention, or alternatively, ineffectiveness.…”

A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children

“…A cohort simulation model is developed to estimate healthcare utilisation costs and health outcomes (number of poison cases in the cost-effectiveness analysis and QALYs in the cost-utility analysis) associated with home safety intervention compared to usual care intervention. The model consists of a decision tree and Markov model structures and is based on two previous decision analytic models that investigated the cost-effectiveness of smoke alarm give-away schemes on health outcomes in children [ 13 , 14 ]. Figure 1 shows the structure of the model with three distinct but interlinked sub-models:

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“… Number of households with safe storage of medicines/Total number of households selected as community controls in case control of risk and protective factors in children under 5 years old (Kendrick et al, paper om press). 1527/2033 = 0.75 Beta pAccept Probability of accepting the intervention Saramago, Cooper et al, 2015 [ 14 ] Assumption based on value in Functional smoke alarm model. Assumed the same for all interventions.…”

“…It assumes poiso n prevention education takes 5 min of health visitor time and the home safety inspection and fitting of locks each take 5 min of safety equipment fitters’ time at £25 per hour. £21.86 Fixed Healthcare costs (Hospital and primary care costs) cAmb Cost of emergency transfers PSSRU [ 19 ] £263 (SE = £21.48) Gamma cED1 Cost of emergency department treatment of cases not leading to hospital inpatient stay (minor injury) PSSRU [ 19 ] £112 (SE = £27.41) Gamma cED2 Cost of emergency department treatment for cases leading to hospital inpatient stay (major injury) PSSRU [ 19 ] £146 (SE = £42.22) Gamma cAdmit1 Cost of a non-elective short (<2 days) inpatient admission PSSRU [ 19 ] £586 (SE = £223.70) Gamma cAdmit2 Cost of a non-elective long (≥2 days) inpatient admission PSSRU [ 19 ] £2461 (SE = £810.37) Gamma cChro Annual cost of chronic ill-health HALO study (Nicholl et al: The Long Term Health and Healthcare Outcomes of Accidental Injury (The HALO Study) Final Report, (Unpublished)) £386.42 (SE = £96.72) Gamma cFatal Cost of fatal injury Saramago et al, 2014 [ 14 ] £205.50 Fixed cGP Cost of 11.7 min GP consultation PSSRU [ 19 ] £43 Fixed a In the base case analysis, assumed that a specified amount of a home visitors time is spent on the poisoning prevention part of the visit. Hence we assumed 5 min of home visitors time is allocated for poisoning education, 5 min of safety fitter’s time for home safety inspection relevant to poisoning prevention and 5 min of safety fitter’s time for fitting two cupboard locks b The Nottingham safety equipment scheme provides a maximum number of items to be installed 2 gates, 2 cupboard catches, window catches, blind chord clips and a bath mat.…”