Cost-effectiveness of Identification and Referral to Improve Safety (IRIS), a domestic violence training and support programme for primary care: a modelling study based on a randomised controlled trial
Cost-effectiveness of Identification and Referral to Improve Safety (IRIS), a domestic violence training and support programme for primary care: a modelling study based on a randomised controlled trial
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DOI：
10.1136/bmjopen-2012-001008
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发表时间：
2012-01-01
期刊：
影响因子：
2.9
通讯作者：
Feder, Gene
中科院分区：
文献类型：
--
作者：
Devine, Angela;Spencer, Anne;Feder, Gene
目的：识别和转诊以提高安全性（IRIS）群集随机对照试验测试了培训和支持干预的有效性，以改善初级保健对遭受家庭暴力（DV）的妇女的反应。本研究的目的是估计这种干预的成本效益。设计：基于马尔可夫模型的成本效益分析。设置：在英国两个城市地区的一般做法。参与者：模拟女性个人从英国一般人口谁是注册在一般做法，年龄16岁及以上。干预：一般做法接受了工作人员培训，提示询问妇女关于电子病历中嵌入的家庭暴力问题，护理途径包括转介给家庭暴力专门机构和该机构的持续联系。该试验比较了24个接受IRIS方案的一般做法与24个未接受该方案的一般做法的妇女向家庭暴力专门机构转介的比率。除了转诊到专业机构的中间结果外，该试验没有衡量妇女的结果。马尔可夫模型外推的试验结果，以估计长期的医疗保健和社会成本和效益，使用其他试验和流行病学研究的数据。结果：干预措施将产生社会成本节约每名妇女注册在英国的一般做法37磅（95%CI 178磅节省成本136）英镑超过1年。每名妇女的质量调整生命年增量估计为0.0010（95%CI-0.0157至0.0101）。概率敏感性分析发现，78%的模型复制下愿意支付的阈值为20磅000每质量调整life-year.Conclusions：IRIS计划很可能是具有成本效益的，并可能节省成本从社会的角度来看。为了建立一个更可靠的模型，需要更好的关于滥用轨迹和宣传效果的数据。试验注册：当前对照试验，ISRCTN 74012786。
Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention.Design: Markov model-based cost-effectiveness analysis.Setting: General practices in two urban areas in the UK.Participants: Simulated female individuals from the general UK population who were registered at general practices, aged 16 years and older.Intervention: General practices received staff training, prompts to ask women about DV embedded in the electronic medical record, a care pathway including referral to a specialist DV agency and continuing contact from that agency. The trial compared the rate of referrals of women with specialist DV agencies from 24 general practices that received the IRIS programme with 24 general practices not receiving the programme. The trial did not measure outcomes for women beyond the intermediate outcome of referral to specialist agencies. The Markov model extrapolated the trial results to estimate the long-term healthcare and societal costs and benefits using data from other trials and epidemiological studies.Results: The intervention would produce societal cost savings per woman registered in the general practice of UK 37 pound (95% CI 178 pound saved to a cost of 136) pound over 1 year. The incremental quality-adjusted life-year was estimated to be 0.0010 (95% CI -0.0157 to 0.0101) per woman. Probabilistic sensitivity analysis found 78% of model replications under a willingness to pay threshold of 20 pound 000 per quality-adjusted life-year.Conclusions: The IRIS programme is likely to be cost-effective and possibly cost saving from a societal perspective. Better data on the trajectory of abuse and the effect of advocacy are needed for a more robust model.Trial registration: Current Controlled Trials, ISRCTN74012786.