Preventing Deaths and Injuries from House Fires: A Cost-Benefit Analysis of a Community-based Smoke Alarm Installation Program

Transcription

1 Preventing Deaths and Injuries from House Fires: A Cost-Benefit Analysis of a Community-based Smoke Alarm Installation Program Safe States 2017 Annual Meeting September 12, 2017 Aurora, CO Slide 1

2 The Injury Prevention Center of Greater Dallas (IPC) was established in 1994 to implement proven, effective primary prevention strategies. 1 1 Injury Prevention of Greater Dallas. Home Page. Slide 2

3 Injury Prevention Center Guiding Principles 1 International Safe Communities Criteria Use data to drive strategies Collaborate with the community Use evidenceinformed strategies Evaluate all interventions Define the Problem Identify Groups at Risk Implement Proven Strategies Evaluate Strategies Slide 3

4 The Facts In 2015, there were 270,500 fires in one- and two-family homes, resulting in 2,155 deaths and 8,050 non-fatal injuries. 2 Represents 66% of total fire deaths and 51% of total fire injuries A functioning smoke alarm reduces the risk of dying by 50%. 3 In house fires reported to U.S. fire departments from , only 53% of the houses had a functional smoke alarm that sounded at the time of the fire. 3 2 Haynes H. Fire Loss in the United States During Quincy, Massachusetts: National Fire Protection Association, Ahrens M. Smoke Alarms in U.S. Home Fires. Quincy, Massachusetts: National Fire Protection Association, 2015 Slide 4

5 Background Operation Installation (OI) An ongoing community-based smoke alarm installation program since ,5 Teams of firefighters (Dallas Fire-Rescue) and volunteers canvas neighborhoods and go door-to-door to install smoke alarms. 36 high-risk census tracts in Dallas, TX are targeted year effectiveness study ( ) 4 : 63% lower house fire death and injury rate in program homes vs non-program homes (3.1 / 100,000 vs 9.6 / 100,000, respectively) Aim of this Study 7 To conduct a retrospective cost-benefit analysis of OI, comparing the program s costs to its effectiveness in preventing deaths and injuries 4 Istre GR, McCoy MA, Moore BJ, et al. Preventing deaths and injuries from house fires: an outcome evaluation of a community-based smoke alarm installation programme. Inj Prev 2014;20: Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residentialfire-related injuries. N Engl J Med 1996;335: Istre GR, McCoy MA, Osborn L, et al. Deaths and injuries from house fires. N Engl J Med 2001;344: Yellman MA, Peterson C, McCoy MA, Stephens-Stidham S, Caton E, Barnard JJ, Padgett TO, Florence C, Istre GR. Preventing deaths and injuries from house fires: a cost benefit analysis of a community-based smoke alarm installation programme. Injury prevention Feb 9:injuryprev Slide 5

6 Operation Installation Program Costs 8 * $189,068 13% $29,908 2% Cost Type ( ) Total Cost of Program $1,483,618 # of Smoke Alarms Installed 25,068 $482,007 34% $723,436 51% Cost per Smoke Alarm Installed $1,483,618 / 25,068 = $59.18 *Costs presented as 2013 US dollars. 8 US Bureau of Labor Statistics. Consumer Price Index All Urban Consumers, U.S. city average (Series ID: CUUR0000SA0,CUUS0000SA0) Personnel Materials Supplies Transportation Slide 6

7 Estimated Cost of OI ( ) Cost observation period ( ) was different than effectiveness study period ( ). Estimated Cost of OI for 10-year Effectiveness Study Time Period $59.18 * 20,127 = $1,191,192 (note: numbers are slightly different due to rounding) Slide 7

8 Cost of Medical Care Ex: Injuries treated in ED for non-program population: 2.3 * $1,846 = $4,199 Non-fatal Injuries Unit Cost 9 With Program Without Program Treated in ED $1,846 $1,846 $4,199 Admitted to Hospital $31,076 $31,076 $70,680 Total (non-fatal) $32,922 $74,878 Fatal Injuries $12,791 $25,582 $99,744 Total Medical Care Costs $58,504 $174,623 9 US Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS), Cost of Injury Reports 2010, Nonfatal Hospitalized Injuries, Both Sexes, All Ages, United States, 2010 [cited 2017 September 11]. Slide 8

9 Cost of Lost Productivity Non-fatal Injuries Unit Cost 9 With Program Without Program Treated in ED $3,863 $3,863 $8,786 Admitted to Hospital $37,684 $37,684 $85,709 Total (non-fatal) $41,547 $94,495 Fatal Injuries $835,288 $1,670,576 $6,513,577 Total Lost Productivity Costs $1,712,123 $6,608,072 Slide 9

10 Total Cost Payer Perspective Program Costs Medical Care Costs Lost Productivity Total With Program $1,191,192 $58, $1,249,696 Without Program Societal Perspective $0 $174, $174,623 With Program $1,191,192 $58,504 $1,712,123 $2,961,819 Without Program $0 $174,623 $6,608,072 $6,782,694 Slide 10

11 Results (Continued) From a Payer Perspective: The incremental cost per fatal/non-fatal injury averted was $128,800. From a Societal Perspective: The incremental cost per fatal/non-fatal injury averted was -$457,763. OI is estimated to have saved $3.8 million. Every $1 spent on OI yielded $3.21 in averted lifetime costs. Program costs could have been over 4 times higher (nearly $250 per smoke alarm installed) or program effectiveness could have been reduced by over 75%, and OI still would have been cost saving. Slide 11

12 Economic Evaluation ( Costing Studies ) Comparing the costs and consequences of an intervention to determine whether an intervention is an efficient use of society s resources. 10 Why? To demonstrate the monetary value of your prevention program Relevant for making decisions about whether or not the implementation of a particular public health program or intervention is worth the financial investment, from an economic perspective 10 Dufour A, Bartram J, editors. Animal waste, water quality and human health. Chaper 12. IWA Publishing; 2012 Oct 14. Slide 12

13 Common Types of Economic Evaluation 11 Cost-Benefit Analysis (CBA) All costs and outcomes are converted into dollar terms Cost-Effectiveness Analysis (CEA) Outcomes are natural health units rather than dollar amounts (Ex: number of lives saved). Usually used to compare two different interventions aimed at the same health outcome Cost-Utility Analysis (CUA) Similar to CEA but combines length of life and quality of life (QALYs or DALYs) 11 National Center for Chronic Disease Prevention and Health Promotion. Five-Part Webcast on Economic Evaluation. Atlanta, GA: Centers for Disease Control and Prevention. [cited 10 Sept 2017]. Slide 13

14 Which Type of Economic Analysis Should I Use? Gray A. Economic Evaluation. In: Dawes, et al. Eds. Evidence Based Practice: A Primer for Health Care Professionals Slide 14

15 Conclusions By using detailed program costs and observed reductions in fire deaths and injuries from a 10-year effectiveness study of Operation Installation, this study supports previous findings that these programs can be cost saving (a positive return on investment). Economic analyses such as these provide a unique tool for decision makers within and outside the field of public health. Slide 15

16 List of Resources 1 Injury Prevention of Greater Dallas. Home Page. 2 Haynes H. Fire Loss in the United States During Quincy, Massachusetts: National Fire Protection Association, Ahrens M. Smoke Alarms in U.S. Home Fires. Quincy, Massachusetts: National Fire Protection Association, Istre GR, McCoy MA, Moore BJ, et al. Preventing deaths and injuries from house fires: an outcome evaluation of a communitybased smoke alarm installation programme. Inj Prev 2014;20: Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residential fire-related injuries. N Engl J Med 1996;335: Istre GR, McCoy MA, Osborn L, et al. Deaths and injuries from house fires. N Engl J Med 2001;344: Yellman MA, Peterson C, McCoy MA, Stephens-Stidham S, Caton E, Barnard JJ, Padgett TO, Florence C, Istre GR. Preventing deaths and injuries from house fires: a cost benefit analysis of a community-based smoke alarm installation programme. Injury prevention Feb 9:injuryprev US Bureau of Labor Statistics. Consumer Price Index All Urban Consumers, U.S. city average (Series ID: CUUR0000SA0,CUUS0000SA0) US Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS), Cost of Injury Reports 2010, Nonfatal Hospitalized Injuries, Both Sexes, All Ages, United States, 2010 [cited 2017 September 11] Dufour A, Bartram J, editors. Animal waste, water quality and human health. Chaper 12. IWA Publishing; 2012 Oct National Center for Chronic Disease Prevention and Health Promotion. Five-Part Webcast on Economic Evaluation. Atlanta, GA: Centers for Disease Control and Prevention. [cited 10 Sept 2017] Gray A. Economic Evaluation. In: Dawes, et al. Eds. Evidence Based Practice: A Primer for Health Care Professionals Slide 16

17 Acknowledgments Thank you to the following individuals and groups: Cora Peterson Curtis Florence The Dallas Fire-Rescue Department Slide 17

18 Merissa Yellman Shelli Stephens-Stidham Mary A. McCoy Emily Caton Jeffrey J. Barnard Ted O. Padgett Jr. Gregory R. Istre Slide 18