RT Journal Article
SR Electronic
T1 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
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e021256
DO 10.1136/bmjopen-2017-021256
VO 8
IS 8
A1 Estela Capelas Barbosa
A1 Talitha Irene Verhoef
A1 Steve Morris
A1 Francesca Solmi
A1 Medina Johnson
A1 Alex Sohal
A1 Farah El-Shogri
A1 Susanna Dowrick
A1 Clare Ronalds
A1 Chris Griffiths
A1 Sandra Eldridge
A1 Natalia V Lewis
A1 Angela Devine
A1 Anne Spencer
A1 Gene Feder
YR 2018
UL http://bmjopen.bmj.com/content/8/8/e021256.abstract
AB 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.