Background Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011.
Objective To estimate the cost–benefit of OI.
Methods A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006–2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001–2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database.
Results From a combined payers' perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective.
Conclusions Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.
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Contributors MAY led the study design and interpretation of results, conducted data analysis, drafted and edited the manuscript, and approved the final manuscript as submitted. CP led the study design and interpretation of results, conducted data analysis, drafted and edited the manuscript, and approved the final manuscript as submitted. MAMC, EC, JJB and TOP Jr assisted with data collection, edited the manuscript and approved the final manuscript as submitted. SS-S assisted with the study design, edited the manuscript and approved the final manuscript as submitted. CF and GRI assisted with the study design and interpretation of results, edited the manuscript and approved the final manuscript as submitted.
Funding Funded in part from Grant 1 H28 CE000840-01, National Center for Injury Prevention and Control, Centers for Disease Control, US Department of Health and Human Services and Subcontract #727922 from the University of Washington, Seattle, Washington.
Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centres for Disease Control and Prevention.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Final results are calculable from data presented in the tables. Unit inputs (ie, costs and effectiveness) are primarily derived from published sources as cited. Data and calculations that were used to estimate programme costs by category and year are available from authors upon request.
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