Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up.
The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.
Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA. miller@pire.org.|Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. miller@pire.org.
Ted R
TR
Miller
Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. D.V.Hendrie@curtin.edu.au.
Delia
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Hendrie
D003365:Costs and Cost Analysis; D022143:Family Nursing / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D006792:House Calls / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D064691:Nurses, Community Health / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D019982:Organizational Case Studies; D011181:Postnatal Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D014481:United States
Cost; Economies of scale; Home visitation; Operational program; Randomized trial