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

Estela Capelas Barbosa, Talitha Irene Verhoef, Steve Morris, Francesca Solmi, Medina Johnson, Alex Sohal, Farah El-Shogri, Susanna Dowrick, Clare Ronalds, Chris Griffiths, Sandra Eldridge, Angela Devine, Anne Spencer, Gene Feder

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Abstract

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.

Original languageEnglish
Article numbere021256
Number of pages10
JournalBMJ Open
Volume8
Issue number8
Early online date29 Aug 2018
DOIs
Publication statusPublished - Aug 2018

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  • Cite this

    Barbosa, E. C., Verhoef, T. I., Morris, S., Solmi, F., Johnson, M., Sohal, A., El-Shogri, F., Dowrick, S., Ronalds, C., Griffiths, C., Eldridge, S., Devine, A., Spencer, A., & Feder, G. (2018). 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. BMJ Open, 8(8), [e021256]. https://doi.org/10.1136/bmjopen-2017-021256