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Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study
  1. Estela Capelas Barbosa1,
  2. Talitha Irene Verhoef1,
  3. Steve Morris1,
  4. Francesca Solmi2,
  5. Medina Johnson3,
  6. Alex Sohal4,
  7. Farah El-Shogri4,
  8. Susanna Dowrick4,
  9. Clare Ronalds5,
  10. Chris Griffiths4,6,
  11. Sandra Eldridge4,
  12. Natalia V Lewis4,
  13. Angela Devine7,8,
  14. Anne Spencer9,
  15. Gene Feder10
  1. 1 University College London, Department of Applied Health Research, London, UK
  2. 2 Division of Psychiatry, University College London, London, UK
  3. 3 IRISi Interventions, Chepstow, UK
  4. 4 NIHR CLAHRC North Thames at Bart’s Health NHS Trust, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  5. 5 Pankhurst Trust Incorporating, Manchester Women’s Aid, Manchester, UK
  6. 6 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  7. 7 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  8. 8 Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
  9. 9 University of Exeter Medical School, Exeter, Devon, UK
  10. 10 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Estela Capelas Barbosa; e.barbosa{at}


Objectives To evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.

Design and setting Cost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.

Participants Based on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.

Interventions The IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.

Results The IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.

Conclusion The IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.

  • domestic violence
  • intimate partner violence
  • training programme
  • general practice
  • family medicine primary care
  • cost-effectiveness

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  • Contributors SM, CG, SE, AS and GF have designed the study. EB, TV, SM, FS and AD have developed the Markov model and carried out the analysis of data. AS, FES, SD, CR, NVL and MJ have collected and validated the data. EB and SM have produced the initial draft. All authors have critically revised the manuscript and approved the final version.

  • Funding This research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust.

  • Competing interests MJ has been paid by the IRIS project since 2007 for employment as an IRIS Advocate Educator and then as a National Implementation Manager. She is currently paid by IRISi, a social enterprise that is promoting the commissioning of the IRIS programme, for employment as Chief Executive. GF reports grants from National Institute for Health Research (NIHR), during the conduct of the study; and he is a non-executive board member of IRISi.

  • Patient consent Not required.

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

  • Data sharing statement The anonymised data used in this study can be obtained from the corresponding author.

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