Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

Abstract

ObjectivesTo evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.Design and settingCost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.ParticipantsBased on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.InterventionsThe IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.ResultsThe IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.ConclusionThe IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.

Implementation of the Identification and Referral to Improve Safety programme for patients with experience of domestic violence and abuse: A theory‐based mixed‐method process evaluation

“…Informed by the Medical Research Council guidance on evaluating complex interventions (Moore et al, ; MRC, ), we conducted a theory‐based mixed‐method process evaluation of the implementation of IRIS which included: (a) a case study; (b) a survey; (c) qualitative analysis of free‐text comments from the survey; (d) qualitative interviews; (e) document review. This process evaluation was carried out alongside the evaluation of the outcomes (Sohal et al, ) and cost‐effectiveness (Barbosa et al, ). The choice of the theoretical and analytical frameworks, study design and methods were influenced by the complexity of the IRIS intervention, the target audience of people involved in implementation of DVA programmes and the experience of the research team.…”

Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

“…IRIS advocate educator (AE) who receives referrals directly from trained clinicians, sees patients affected by DVA, usually within the practice, dispensing expert advocacy and ensuring direct access for women to specialist abuse services. Women can also self-refer if they see IRIS publicity material displayed within a practice [17].…”

“…In our interrupted time series study [17], in two boroughs the provision of IRIS service was disrupted for a period of three and six months respectively. Our research question is whether the service disruption in each borough had an effect on the referral rate, during the period within which the disruption occurred.…”

“…Implementation of IRIS outside of a trial [16] resulted in a large increase in referrals received by DVA service providers (3024%; 95%CI=(2055%,4477%)), with no increase in 61 general practices in the fth borough that did not fund IRIS, but instead provided DVA information sessions to which general practice clinicians were invited [17]. IRIS outside the trial setting is also cost-effective, from the NHS and societal perspective, good value for the NHS, cost saving for society -incremental net monetary bene t was £22 and £42 respectively [18].…”

Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation

“…Implementation of IRIS outside of a trial [16] resulted in a large increase in referrals received by DVA service providers (3024%; 95%CI=(2055%,4477%)), with no increase in 61 general practices in the fifth borough that did not fund IRIS, but instead provided DVA information sessions to which general practice clinicians were invited [17]. IRIS outside the trial setting is also cost-effective, from the NHS and societal perspective, good value for the NHS, cost saving for society -incremental net monetary benefit was £22 and £42 respectively [18]. A mixed method implementation process evaluation and a qualitative study found that staff mix and IRIS' joined up approach, bridging the planets of general practice and specialist domestic abuse support services is crucial to making IRIS work [19,20].…”