title: Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study.
abstract: BACKGROUND
  The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK.
  
  
  METHODS
  We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection.
  
  
  RESULTS
  Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household.
  
  
  CONCLUSIONS
  Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.
authors.forename: Pedro
authors.initials: P
authors.lastname: Saramago
authors.affiliation: Department of Health Sciences, University of Leicester, 2nd Floor Adrian Building, University Road, Leicester LE1 7RH, UK. njc21@leicester.ac.uk.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Cooper
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
authors.forename: Mike
authors.initials: M
authors.lastname: Hayes
authors.forename: Ken
authors.initials: K
authors.lastname: Dunn
authors.forename: Andrea
authors.initials: A
authors.lastname: Manca
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
mesh_terms: D000293:Adolescent; D002056:Burns / Q000517:prevention & control*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D010067:Ownership; D011482:Protective Devices / Q000191:economics / Q000706:statistics & numerical data*; D012449:Safety