Citation

Barbosa EC, Verhoef TI, Morris S, Solmi F, Johnson M, Sohal A, El-Shogri F, Dowrick S, Ronalds C, Griffiths C, Eldridge S, Lewis NV, Devine A, Spencer A, Feder G. BMJ Open 2018; 8(8): e021256.

Affiliation

School of Social and Community Medicine, University of Bristol, Bristol, UK.

Copyright

(Copyright © 2018, BMJ Publishing Group)

DOI

10.1136/bmjopen-2017-021256

PMID

30158224

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.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.

Language: en

Keywords

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