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Cost-effectiveness of England’s national ‘Safe At Home’ scheme for reducing hospital admissions for unintentional injury in children aged under 5
  1. Matthew Jones1,
  2. Trevor Hill1,
  3. Carol Coupland1,
  4. Denise Kendrick1,
  5. Ashley Akbari2,
  6. Sarah Rodgers3,
  7. Michael Craig Watson4,
  8. Edward Tyrrell5,
  9. Sheila Merrill6,
  10. Ashley Martin6,
  11. Elizabeth Orton1
  1. 1Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  2. 2Faculty of Medicine, Health, & Life Science, University of Wales Swansea, Swansea, UK
  3. 3Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
  4. 4Institute of Health Promotion and Education, Lichfield, UK
  5. 5Unit of Lifespan and Population Health, University of Nottingham, Nottingham, UK
  6. 6Royal Society for the Prevention of Accidents (RoSPA), Edgbaston, UK
  1. Correspondence to Dr Matthew Jones, Unit of Lifespan and Population Health, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham NG7 2RD, UK; matthew.jones3{at}nottingham.ac.uk

Abstract

Background Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The ‘Safe at Home’ (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness.

Materials and methods Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0–2, implementation); T2 (years 3–4) and T3 (years 5–6). Analyses were conducted for T2 versus T1 and T3 versus T1.

Results Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH.

Conclusion SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.

  • child survival
  • economic analysis
  • passive safety
  • costs

Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. The data used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP gives careful consideration to each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting safe haven and remote access system referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. The HES Data (copyright 2021) was reused with the permission of the Health and Social Care Information Centre. All rights reserved. Data sharing agreement number DARS-NIC-50919-D5R5D-V1.4.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. The data used in this study are available in the SAIL Databank at Swansea University, Swansea, UK, but as restrictions apply, they are not publicly available. All proposals to use SAIL data are subject to review by an independent Information Governance Review Panel (IGRP). Before any data can be accessed, approval must be given by the IGRP. The IGRP gives careful consideration to each project to ensure proper and appropriate use of SAIL data. When access has been granted, it is gained through a privacy protecting safe haven and remote access system referred to as the SAIL Gateway. SAIL has established an application process to be followed by anyone who would like to access data via SAIL at https://www.saildatabank.com/application-process. The HES Data (copyright 2021) was reused with the permission of the Health and Social Care Information Centre. All rights reserved. Data sharing agreement number DARS-NIC-50919-D5R5D-V1.4.

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Footnotes

  • Twitter @AshleyAkbari

  • Contributors EO, DK, CC, ET, MJ, SR, SM and MCW designed and obtained funding for the study. MJ undertook the analysis in consultation with all authors. AA provided expert advice regarding information governance and data management. All authors contributed to the manuscript. EO took overall responsibility for the study. MJ accepts full responsibility for the finished work and conduct of the study, access to the data, and the decision to publish.

  • Funding This project was supported by a grant by the National Institute for Health Research School of Primary Care Research (Reference Number 362). Time for SR to contribute to this project was funded by The National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC).

  • Competing interests MCW, CC and DK previously evaluated the SafeAt Home scheme in a study funded by RoSPA and published in 2011: https://www.rospa.com/rospaweb/docs/advice-services/home-safety/final-evaluation-reportsafe-at-home.pdf. RoSPA received funding from the UK government to manage and implement the Safe At Home scheme.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.