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Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5

Jones, Matthew; Hill, Trevor; Coupland, Carol; Kendrick, Denise; Akbari, Ashley; Rodgers, Sarah; Watson, Michael Craig; Tyrrell, Edward; Merrill, Sheila; Martin, Ashley; Orton, Elizabeth


Assistant Professor in Health Economics

Professor of Medical Statistics

Professor of Primary Care Research

Ashley Akbari

Sarah Rodgers

Michael Craig Watson

Sheila Merrill

Ashley Martin


Background: Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness. Materials and methods: Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1. Results: Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH. Conclusion: SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.


Jones, M., Hill, T., Coupland, C., Kendrick, D., Akbari, A., Rodgers, S., …Orton, E. (2022). Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5. Injury Prevention,

Journal Article Type Article
Acceptance Date Nov 6, 2022
Online Publication Date Dec 6, 2022
Publication Date Dec 6, 2022
Deposit Date Jan 5, 2023
Publicly Available Date Dec 7, 2023
Journal Injury Prevention
Print ISSN 1353-8047
Electronic ISSN 1475-5785
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Keywords Public Health, Environmental and Occupational Health
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