Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes
- Health Economics and Social Policy Group, Division of Health Science, University of South Australia, Adelaide, Australia
- Correspondence to Dr Kim Dalziel, Health Economics and Social Policy Group, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5095, Australia;
Contributors KD was involved in obtaining funding, and conception and design of the research. She supervised the systematic review to select interventions and obtain effectiveness data. She led the economic analysis and drafted the manuscript, including the first draft of the manuscript. LS led the process of obtaining funding, and conception and design of the research. She oversaw the systematic review and economic analysis, and was involved in revising the manuscript. Both authors have approved the final version of the manuscript.
- Received 4 August 2012
- Accepted 6 May 2012
- Published Online First 4 July 2012
Objective There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy.
Study design All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted.
Results 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800–US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets.
Conclusions There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.
Funding The Australian Research Council provided funding for this study.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.