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Journal of Public Health Advance Access published online on June 4, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp047
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

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.


  Abstract

The objective of the study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and post-natal periods in reducing the risk of abuse and neglect in the first year of life. 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). A cost-effectiveness analysis of this public health intervention was undertaken from a societal perspective. The mean 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 in the control and intervention arms were £3324 and £5685, respectively, a difference of £2361 (P < 0.000). One of the three independent objective assessments, predictive of infant abuse and neglect, showed improvements in maternal sensitivity (P < 0.04) and infant cooperativeness (P < 0.02) in the intervention arm. 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. The results of the study provide tentative evidence to suggest that, within the context of regular home visits, specially trained health 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. These potential benefits were delivered at an incremental societal cost of £3246 per woman.

Keywords: Economics, public health, health services


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