title: Saving lives and saving money: hospital-based violence intervention is cost-effective.
abstract: BACKGROUND
  Victims of violence are at significant risk for injury recidivism, including fatality. We previously demonstrated that our hospital-based violence intervention program (VIP) resulted in a fourfold reduction in injury recidivism, avoiding trauma care costs of $41,000 per injury. Given limited trauma center resources, assessing cost-effectiveness of interventions is fundamental to inform use of these programs in other institutions. This study examines the cost-effectiveness of hospital-based VIP.
  
  
  METHODS
  We used a decision tree and Markov disease state modeling to analyze cost utility for a hypothetical cohort of violently injured subjects, comparing VIP versus no VIP at a trauma center. Quality-adjusted life-years (QALYs) were calculated using differences in mortality and published health state utilities. Costs of trauma care and VIP were obtained from institutional data, and risk of recidivism with and without VIP were obtained from our trial. Outcomes were QALYs gained and net costs over a 5-year horizon. Sensitivity analyses examined the impact of uncertainty in input values on results.
  
  
  RESULTS
  VIP results in an estimated 25.58 QALYs and net costs (program plus trauma care) of $5,892 per patient. Without VIP, these values are 25.34 and $5,923, respectively, suggesting that VIP yields substantial health benefits (24 QALYs) and savings ($4,100) if implemented for 100 individuals. In the sensitivity analysis, net QALYs gained with VIP nearly triple when the injury recidivism rate without VIP is highest. Cost-effectiveness remained robust over a range of values; $6,000 net cost savings occur when 5-year recidivism rate without VIP is at 7%.
  
  
  CONCLUSIONS
  VIP costs less than having no VIP with significant gains in QALYs especially at anticipated program scale. Across a range of plausible values at which VIP would be less cost-effective (lower injury recidivism, cost of injury, and program effectiveness), VIP still results in acceptable cost per health outcome gained. VIP is effective and cost-effective and should be considered in any trauma center that takes care of violently injured patients. Our analyses can be used to estimate VIP costs and results in different settings.
  
  
  METHODS
  Economic and value-based evaluation, level 2.
authors.affiliation: From the San Francisco General Hospital (C.J., R.A.D.), Global Health Sciences (N.A.), and Institute for Health Policy Studies (J.G.K.), University of California-San Francisco, San Francisco; and University of California, San Francisco-East Bay-Highland Hospital (R.S., A.G.), Oakland, California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Juillard
authors.forename: Randi
authors.initials: R
authors.lastname: Smith
authors.forename: Nancy
authors.initials: N
authors.lastname: Anaya
authors.forename: Arturo
authors.initials: A
authors.lastname: Garcia
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
mesh_terms: D000328:Adult; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004469:Economics, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D016896:Treatment Outcome; D014754:Violence / Q000191:economics* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000191:economics* / Q000517:prevention & control*