Journal of Public Health Advance Access originally published online on June 4, 2009
Journal of Public Health 2009 31(3):423-433; doi:10.1093/pubmed/fdp047
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Economic evaluation of an intensive home visiting programme for vulnerable families: a cost-effectiveness analysis of a public health intervention
Emma McIntosh, Senior Research Officer1
Jane Barlow, Professor of Public Health2
Hilton Davis, Professor of Child Health Psychology3
Sarah Stewart-Brown, Director of the Health Sciences Research Institute1
1 Health Economics Research Centre, Department of Public Health, Oxford, UK
2 Warwick Medical School, University of Warwick, Coventry, UK
3 Centre for Parent and Child Support, Kings College London, London, UK
Address correspondence to Emma McIntosh, E-mail: emma.mcintosh{at}dphpc.ox.ac.uk
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Abstract |
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Background Recent reviews have shown that home visiting programmes that address parenting have the potential to improve long term health and social outcomes for children. However there are few studies exploring the cost-effectiveness of such interventions. The objective of this study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and postnatal periods.
Methods The design was an economic evaluation alongside a multicentre randomized controlled trial, in which 131 eligible women were randomly allocated to receive 18 months of intensive home visiting (n=67) or standard services (n=64). Due to the public health nature of the intervention a cost-effectiveness analysis was undertaken from a societal perspective.
Results The mean ‘societal costs’ in the control and intervention arms were £3874 and £7120, respectively, a difference of £3246 (p<0.000). The mean ‘health service only’ costs were £3324 and £5685 respectively, a difference of £2361 (p<0.000). As well as significant improvements in maternal sensitivity and infant cooperativeness there was also a non-significant increase in the likelihood of the intervention group infants being removed from the home due to abuse and neglect. These incremental benefits were delivered at an incremental societal cost of £3246 per woman.
Conclusions The results of the study provide evidence to suggest that, within the context of regular home visits, specially trained home visitors can increase maternal sensitivity and infant cooperativeness and are better able to identify infants in need of removal from the home for child protection. The extent to which these benefits are ‘worth’ the societal cost of £3246 per woman however is a matter of judgment.
Keywords: economics, public health, health services