Jones Matthew, Orton Elizabeth, Taylor Michael James, Timblin Clare, Clarke Rachel, Watson Michael Craig, Hayes Mike, Patel Tina, Coupland Carol, Kendrick Denise
Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Inj Prev. 2025 Jan 23;31(1):45-51. doi: 10.1136/ip-2024-045236.
Unintentional injuries are a common cause of morbidity and mortality in the under-5s, but undertaking home safety practices can reduce injury risk. Stay One Step Ahead (SOSA) is an evidence-based standardised home safety programme. This study evaluates the cost-effectiveness of SOSA versus usual care in Nottingham, UK.
Cost-effectiveness analysis from a National Health Service and personal social services perspective. SOSA activity data, injury occurrence and associated short-term healthcare costs were collected within a controlled before-and-after study from 2017 to 2020. The primary outcome was the incremental cost-effectiveness ratio (ICER) per additional home adopting three key safety practices (working smoke alarm, safe poisons storage and fitted stair gate). Secondary outcomes were ICERs per injury avoided and quality-adjusted life-years (QALYs) gained.
SOSA costs £30 per child but reduces short-term healthcare expenditure by £42. SOSA increased the number of homes with three key safety practices by 0.02 per child, reduced injuries per child by 0.15 and gained 0.0036 QALYs per child. SOSA was dominant as it was cheaper and more effective than current practice. ICERs were -£590 per additional home deemed safe, -£77 per injury avoided and -£3225 per QALY gained. Focusing on healthcare expenditure alone, SOSA saved £1.39 for every pound spent.
SOSA is a cost-saving intervention. Commissioners should consider implementing SOSA.
意外伤害是5岁以下儿童发病和死亡的常见原因，但采取家庭安全措施可降低受伤风险。“领先一步”（SOSA）是一项基于证据的标准化家庭安全计划。本研究评估了在英国诺丁汉，SOSA与常规护理相比的成本效益。
从国民医疗服务体系和个人社会服务的角度进行成本效益分析。在2017年至2020年的一项对照前后研究中，收集了SOSA活动数据、伤害发生情况及相关短期医疗费用。主要结果是每增加一个采用三项关键安全措施（正常工作的烟雾报警器、安全储存毒药和安装楼梯门）的家庭的增量成本效益比（ICER）。次要结果是避免每起伤害的ICER和获得的质量调整生命年（QALY）。
SOSA每个儿童花费30英镑，但可将短期医疗支出减少42英镑。SOSA使每个儿童拥有三项关键安全措施的家庭数量增加0.02，每个儿童受伤数量减少0.15，并使每个儿童获得0.0036个QALY。SOSA占主导地位，因为它比现行做法更便宜且更有效。每增加一个被视为安全的家庭，ICER为-590英镑；每避免一起伤害，ICER为-77英镑；每获得一个QALY，ICER为-3225英镑。仅关注医疗支出，SOSA每花费1英镑可节省1.39英镑。
SOSA是一种节省成本的干预措施。决策者应考虑实施SOSA。
