Economic evaluation of an intensive home visiting programme for vulnerable families: a cost-effectiveness analysis of a public health intervention

Recent reviews have shown that home visiting programmes that address parenting have the potential to improve long term health and social outcomes for children. However there are few studies exploring the cost-effectiveness of such interventions. The objective of this study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and postnatal periods. The design was an economic evaluation alongside a multicentre randomized controlled trial, in which 131 eligible women were randomly allocated to receive 18 months of intensive home visiting (n=67) or standard services (n=64). Due to the public health nature of the intervention a cost-effectiveness analysis was undertaken from a societal perspective. The mean 'societal costs' in the control and intervention arms were 3874 pound and 7120 pound, respectively, a difference of 3246 pound (p < 0.000). The mean 'health service only' costs were 3324 pound and 5685 pound respectively, a difference of 2361 pound (p < 0.000). As well as significant improvements in maternal sensitivity and infant cooperativeness there was also a non-significant increase in the likelihood of the intervention group infants being removed from the home due to abuse and neglect. These incremental benefits were delivered at an incremental societal cost of 3246 pound per woman. The results of the study provide evidence to suggest that, within the context of regular home visits, specially trained home visitors can increase maternal sensitivity and infant cooperativeness and are better able to identify infants in need of removal from the home for child protection. The extent to which these benefits are 'worth' the societal cost of 3246 pound per woman however is a matter of judgment.