TY - JOUR
T1 - Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world
T2 - Updated modelling based on an MRC phase IV observational pragmatic implementation study
AU - Barbosa, Estela Capelas
AU - Verhoef, Talitha Irene
AU - Morris, Steve
AU - Solmi, Francesca
AU - Johnson, Medina
AU - Sohal, Alex
AU - El-Shogri, Farah
AU - Dowrick, Susanna
AU - Ronalds, Clare
AU - Griffiths, Chris
AU - Eldridge, Sandra
AU - Lewis, Natalia V.
AU - Devine, Angela
AU - Spencer, Anne
AU - Feder, Gene
N1 - Funding Information:
This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust.
Publisher Copyright:
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Objectives To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon. Design and setting Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England. Participants Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older. Interventions The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context. Results The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence. Conclusion The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.
AB - Objectives To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon. Design and setting Cost-utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England. Participants Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older. Interventions The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context. Results The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval -£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval -0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence. Conclusion The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.
KW - cost-effectiveness
KW - domestic violence
KW - family medicine primary care
KW - general practice
KW - intimate partner violence
KW - training programme
UR - http://www.scopus.com/inward/record.url?scp=85052732583&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2017-021256
DO - 10.1136/bmjopen-2017-021256
M3 - Article
C2 - 30158224
AN - SCOPUS:85052732583
VL - 8
SP - 1
EP - 10
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 8
M1 - e021256
ER -