Achana Felix, Sutton Alex J, Kendrick Denise, Hayes Mike, Jones David R, Hubbard Stephanie J, Cooper Nicola J
Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
BMC Public Health. 2016 Aug 3;15:705. doi: 10.1186/s12889-016-3334-0.
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.
系统评价和网络荟萃分析表明，无论是否提供安全设备，家庭安全教育在促进有儿童家庭的预防中毒行为方面都是有效的。本文比较了家庭安全干预措施在促进预防中毒实践方面的成本效益。
一个概率性决策分析模型模拟了一个假设的5岁以下儿童队列的医疗保健成本和效益。该模型比较了家庭安全教育、家庭安全检查、提供免费或低成本安全设备以及安装设备的成本效益。分析是从英国国家医疗服务体系和个人社会服务的角度进行的，并以2012年的价格表示。
不进行安全检查、不提供或不安装设备的教育是促进安全储存药品最具成本效益的策略，与常规护理相比，每避免一例中毒病例的增量成本效益比为2888英镑（95%可信区间（CrI）为1990 - 5774英镑），或每获得一个质量调整生命年（QALY）的成本效益比为41330英镑（95%CrI为20007 - 91534英镑）。与常规护理相比，家庭安全干预措施在促进安全储存其他家用产品方面不具有成本效益。
对于预防药物中毒，教育比更密集但昂贵的策略性价比更高，但对于贫困地区有一个以上孩子的家庭，每获得一个QALY的成本效益可能仅在30000英镑时才具有成本效益。由于模型参数的证据不足，成本效益估计存在相当大的不确定性。政策制定者应考虑相互竞争的干预措施的成本和效益，以确保资源的有效利用。
