BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; Department of Pediatrics, University of British Columbia, Address: UBC Faculty of Medicine, Rm 2D19 4480 Oak Street, BC Children's Hospital, Vancouver, BC, V6H 3V4, Canada.
BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada.
Child Abuse Negl. 2019 Nov;97:104133. doi: 10.1016/j.chiabu.2019.104133. Epub 2019 Aug 29.
Abusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported.
This study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program.
Children aged 0-24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study.
An incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services' perspectives using decision tree models.
There were sixty-four AHT events between 2002-2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system.
This study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.
虐待性头部外伤（AHT）是一种严重的儿童虐待形式，会给儿童及其家庭带来毁灭性的后果，但在加拿大，其经济成本尚未确定。“PURPLE 哭声期”（PURPLE）项目是一项在不列颠哥伦比亚省实施的 AHT 预防项目，最近有报道称该项目成功降低了 AHT 事件的发生率。
本研究旨在估算偶然发生的 AHT 事件对社会造成的终身成本，并比较在实施 PURPLE 项目前后 AHT 的效益和相关成本。
本研究纳入了 2002 年至 2014 年期间在不列颠哥伦比亚省被明确诊断为 AHT 的 0-24 月龄儿童。
采用基于发病率的疾病成本分析方法，使用人力资本法，根据严重程度（最轻微、严重和致命）量化 AHT 事件的终身成本。采用决策树模型，从社会和卫生服务两个角度对 PURPLE 项目进行成本效益分析。
2002-2014 年期间共发生 64 例 AHT 事件，给社会造成的总成本为 35435.908 万美元。致命、严重和最轻微 AHT 的相关成本分别为 714.7548 万美元、6057.761 万美元和 167.5099 万美元。通过 PURPLE 项目向每个新生儿投资 5 美元，可使社会和医疗保健系统分别避免 273.52 美元和 14.49 美元的儿童成本。
本研究为政策制定者和卫生保健从业者提供了证据，表明投资于成熟的 AHT 预防项目（如 PURPLE）不仅可以促进儿童安全和健康，还可以为社会带来成本节约。
