Diamond-Smith Nadia, Bishai David, Perry Elise, Shields Wendy, Gielen Andrea
Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Inj Prev. 2014 Aug;20(4):251-7. doi: 10.1136/injuryprev-2013-040885. Epub 2013 Oct 23.
This paper analyses costs and potential lives saved from a door-to-door smoke alarm distribution programme using data from a programme run by the Baltimore City Fire Department in 2010-2011.
We evaluate the impact of a standard home visit programme and an enhanced home visit programme that includes having community health workers provide advance notice, promote the programme, and accompany fire department personnel on the day of the home visit, compared with each other and with an option of not having a home visit programme (control).
Study data show that the home visit programme increased by 10% the number of homes that went from having no working alarm to having any working alarm, and the enhanced programme added an additional 1% to the number of homes protected. We use published reports on the relative risk of death in homes with and without a working smoke alarm to show that the standard programme would save an additional 0.24 lives per 10,000 homes over 10 years, compared with control areas and the enhanced home visit programme saved an additional 0.07 lives compared with the standard programme. The incremental cost of each life saved for the standard programme compared with control was $28,252 per death averted and $284,501per additional death averted for the enhanced compared with the standard.
Following the US guidelines for the value of a life, both programmes are cost effective, however, the standard programme may offer a better value in terms of dollars per death averted. The study also highlights the need for better data on the benefits of current smoke alarm recommendations and their impact on injury, death and property damage.
本文利用巴尔的摩市消防局2010 - 2011年开展的一项计划的数据，分析挨家挨户分发烟雾报警器计划的成本和可能挽救的生命。
我们评估了标准家访计划和强化家访计划的影响，强化家访计划包括让社区卫生工作者提前通知、宣传该计划，并在家访当天陪同消防部门人员，将这两个计划相互比较，同时与不进行家访计划（对照）的选项进行比较。
研究数据表明，家访计划使没有有效报警器的家庭增加到拥有任何有效报警器的家庭数量增加了10%，而强化计划使得到保护的家庭数量又增加了1%。我们利用已发表的关于有和没有有效烟雾报警器的家庭中死亡相对风险的报告表明，与对照区域相比，标准计划在10年内每10000户家庭可额外挽救0.24条生命，与标准计划相比，强化家访计划可额外挽救0.07条生命。与对照相比，标准计划挽救每条生命的增量成本为避免每例死亡28252美元，与标准计划相比，强化计划避免每例额外死亡的增量成本为284501美元。
按照美国关于生命价值的指导方针，这两个计划都具有成本效益，然而，就避免每例死亡的美元数而言，标准计划可能提供更好的价值。该研究还强调需要更好的数据来了解当前烟雾报警器建议的益处及其对伤害、死亡和财产损失的影响。
