title: A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children.
abstract: Systematic reviews and a network meta-analysis show home safety education with or without the provision of safety equipment is effective in promoting poison prevention behaviours in households with children. This paper compares the cost-effectiveness of home safety interventions to promote poison prevention practices.
  
  
  
  A probabilistic decision-analytic model simulates healthcare costs and benefits for a hypothetical cohort of under 5 year olds. The model compares the cost-effectiveness of home safety education, home safety inspections, provision of free or low cost safety equipment and fitting of equipment. Analyses are conducted from a UK National Health Service and Personal Social Services perspective and expressed in 2012 prices.
  
  
  
  Education without safety inspection, provision or fitting of equipment was the most cost-effective strategy for promoting safe storage of medicines with an incremental cost-effectiveness ratio of £2888 (95 % credible interval (CrI) £1990-£5774) per poison case avoided or £41,330 (95%CrI £20,007-£91,534) per QALY gained compared with usual care. Compared to usual care, home safety interventions were not cost-effective in promoting safe storage of other household products.
  
  
  
  Education offers better value for money than more intensive but expensive strategies for preventing medicinal poisonings, but is only likely to be cost-effective at £30,000 per QALY gained for families in disadvantaged areas and for those with more than one child. There was considerable uncertainty in cost-effectiveness estimates due to paucity of evidence on model parameters. Policy makers should consider both costs and effectiveness of competing interventions to ensure efficient use of resources.
authors.affiliation: Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. f.achana@warwick.ac.uk.
authors.forename: Felix
authors.identifier: 0000-0002-8727-9125
authors.initials: F
authors.lastname: Achana
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
authors.affiliation: Child Accident Prevention Trust, London, SE16 4DG, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Hayes
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Hubbard
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Cooper
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005191:Family Characteristics; D005260:Female; D017048:Health Care Costs; D006266:Health Education / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D011041:Poisoning; D011042:Poisons; D011482:Protective Devices / Q000191:economics; D019057:Quality-Adjusted Life Years; D012449:Safety; D012947:Social Work; D012959:Socioeconomic Factors; D006113:United Kingdom
chemical_list: D011042:Poisons
keywords: Children; Decision models; Economic evaluation; Injury prevention; Poisonings; Public health