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Title: 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
Authors: 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
Natalia V. Lewis
Angela Devine
Anne Spencer
Gene Feder
University of Exeter Medical School
Queen Mary, University of London
University of Bristol
Mahidol University
Nuffield Department of Clinical Medicine
IRISi Interventions
Pankhurst Trust Incorporating
Keywords: Medicine
Issue Date: 1-Aug-2018
Citation: BMJ Open. Vol.8, No.8 (2018)
Abstract: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. 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.
ISSN: 20446055
Appears in Collections:Scopus 2018

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