A cost analysis of a smoke alarm installation and fire safety education program☆
Introduction
Deaths from fires and burns are the sixth most common cause of unintentional injury-related deaths in the United States (Centers for Disease Control and Prevention [CDC], 2005). The U.S. death rate from fire ranks fourth among 25 developed countries (for which statistics are available) (International Association for the Study of Insurance Economics, 2004). The National Fire Protection Association (NFPA) reports that in 2004 approximately 410,500 residential fires occurred, causing approximately 3,190 deaths and 14,175 non-fatal injuries, resulting in over $6 billion in property losses (Karter, 2005). Although these numbers have generally declined in the past 10 years, residential fires remain a substantial public health burden in terms of mortality, disability, and decreases in quality of life.
Most fires and associated injuries are preventable. Smoke alarms have been shown to be an effective, reliable, and inexpensive method of providing early warning in residential fires (Ahrens, 2004). A working smoke alarm reduces the risk of death from residential fire by at least 50% (Ahrens, 2004). Despite this, and although over 90% of homes report having smoke alarms, only about three quarters of U.S. households report having a functioning smoke alarm (Harvey et al., 1998, Neily et al., 1994). Households below the poverty level and households in rural areas are even less likely to have installed smoke alarms (Harvey et al., 1998). A systematic review of controlled trials of interventions to promote smoke alarm use estimates that indirect methods such as counseling and educational interventions had non-significant effects on the likelihood of owning an alarm or having a functioning alarm (DiGuiseppi & Higgins, 2000).
The Centers for Disease Control and Prevention (CDC), U.S. Fire Administration (USFA), Consumer Product Safety Commission (CPSC), and other governmental and non-governmental organizations are collaborating to prevent residential fires in the United States with the goal of eliminating all residential fire-related deaths by 2020. In one of its efforts toward this goal, CDC's Injury Center (the National Center for Injury Prevention and Control) funds state health departments to deliver a smoke alarm installation and fire safety education program (SAIFE) in local communities at high-risk for residential fires.
This effort, which began in 1998, currently funds 16 states to participate and deliver the SAIFE program (Ballesteros, Jackson, & Martin, 2005). For each state, the program consists of intervening in a minimum of two communities, each with a high-risk population of 50,000 or less. High-risk is defined as having fire mortality and incident rates above the state and national averages, and a mean household income below the poverty line. The main activities of the program include staff driving into target neighborhoods, knocking on doors of each individual home on a street, and enrolling homes one-by-one (called “canvassing”); installing alarms; educating participants; and following up with evaluations on a proportion of program homes.
Some programs have attempted to accomplish something similar by distributing vouchers for free alarms or distributing actual free alarms, but these programs have not proven to be effective in getting working alarms into the home (DiGuiseppi et al., 2002, Douglas et al., 1998, Mallonee et al., 1996). Harvey et al. (1998) found that compared to homes that were given vouchers for free alarms, homes that had alarms actually installed were almost five times more likely to have functioning alarms after 6 to 12 months. Additionally, they found that approximately 90% of installation homes had functioning smoke alarms at follow-up, indicating that direct installation of alarms can be an effective means of getting working alarms into homes. The SAIFE program performs direct installations, which is consistent with the evidence described above. However, installation programs are time-consuming and costly. The costs of running these programs have never been studied in detail.
The purpose of this study was to conduct a cost analysis of typical SAIFE programs to assess the economic resources involved in delivering smoke alarm protection and fire safety education to eligible homes in selected communities. Such an analysis can provide information on the cost per alarm installed and how these costs differ across programs of varying size. Ideally, a community interested in implementing a smoke alarm installation program could estimate the program costs based on how many alarms are to be installed.
Section snippets
Methods
For this study, we conducted a retrospective cost analysis of the SAIFE program based on the following state-level criteria: funded since 1998; regular reporting to the National Fire Incidence Reporting System (NFIRS; U.S. Fire Administration, 2005); and geographic dispersion. Of the four states included in the analysis, two worked with two communities each, and two worked with four communities each, for a total of 12 local sites.
Annual program cost data for October 2002 through September 2003
Results
The resources required for implementing each local program and per unit cost data are presented in Tables 1 through 4. As shown in Table 1, the number of hours required to implement program activities by full-time personnel ranged from 170 hours (State B-site 1) to 3,760 hours (State D-site 1). One site had part-time employees involved in program activities for a total of 514 hours (State B-site 1). Volunteers were used in all but three sites, ranging from 812 (State C-site 3) hours to 3,850
Discussion
The results of this analysis indicate that on average it costs a community $59,351 to implement the SAIFE program. Adding in the average state costs, the cost to implement this program in a given community is $76,314, resulting in 585 smoke alarms being installed. A comparison of average local costs per alarm installed shows that as more smoke alarms are installed, the average cost of installing each alarm falls. This finding suggests that the SAIFE program is benefiting from economies of scale.
Acknowledgements
The authors extend their gratitude to the state and local program coordinators who donated their time and expertise. State coordinators include Steve Davidson, Robert McCool, Miriam McGaugh and Suzanne Syzdek. Local coordinators include Chief John Bays, Major Derrick Hall, Sue Patterson, Martina Pulliam, Chief J.D. Rice, Chief Roy Rice, Fred Rion, Chief James Switzer, Chief Jack Thompson, Chief Toni Tolbert, Randy White, and Chief Tim White. We sincerely thank them for all their help and
John E. Parmer is a research assistant in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). He received his master's degree in Public Policy from the Georgia Institute of Technology.
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John E. Parmer is a research assistant in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). He received his master's degree in Public Policy from the Georgia Institute of Technology.
Phaedra S. Corso is the senior health economist in the National Center for Injury Prevention and Control at CDC. Dr. Corso has worked at CDC for over a decade in the areas of economic evaluation and decision analysis, publishing numerous articles on the cost-effectiveness of prevention interventions and co-editing a book on economic evaluation and decision analysis methods for use in public health. She holds a Master's degree in public finance from The University of Georgia and a Ph.D. in health policy, decision sciences, from Harvard University.
Michael F. Ballesteros is an epidemiologist in the National Center for Injury Prevention and Control at CDC. He has worked at CDC for five years conducting research on unintentional injuries. He holds a Master's degree in Preventive Medicince and a Ph.D. in epidemiology from the University of Maryland at Baltimore.
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Note: the findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.