Marginal Cost Analysis of Two Train-the-Trainer Models for Implementing SafeCare

[West J Emerg Med. 2014;15(5):623–626.

Costs of Illness in the 1993 Waterborne Cryptosporidium Outbreak, Milwaukee, Wisconsin

To assess the total medical costs and productivity losses associated with the 1993 waterborne outbreak of cryptosporidiosis in Milwaukee, Wisconsin, including the average cost per person with mild, moderate, and severe illness, we conducted a retrospective cost-of-illness analysis using data from 11 hospitals in the greater Milwaukee area and epidemiologic data collected during the outbreak. The total cost of outbreak-associated illness was $96.2 million:$31.7 million in medical costs and $64.6 million in productivity losses. The average total costs for persons with mild, moderate, and severe illness were$116, $475, and$7,808, respectively. The potentially high cost of waterborne disease outbreaks should be considered in economic decisions regarding the safety of public drinking water supplies

Measuring health-related quality of life for child maltreatment: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>Child maltreatment causes substantial morbidity and mortality in the U.S. Morbidity associated with child maltreatment can reduce health-related quality of life. Accurately measuring the reduction in quality of life associated with child maltreatment is essential to the economic evaluation of educational programs and interventions to reduce the incidence of child maltreatment. The objective of this study was to review the literature for existing approaches and instruments for measuring quality-of-life for child maltreatment outcomes.</p> <p>Methods</p> <p>We reviewed the current literature to identify current approaches to valuing child maltreatment outcomes for economic evaluations. We also reviewed available preference-based generic QOL instruments (EQ-5D, HUI, QWB, SF-6D) for appropriateness in measuring change in quality of life due to child maltreatment.</p> <p>Results</p> <p>We did not identify any studies that directly evaluated quality-of-life in maltreated children. We identified 4 studies that evaluated quality of life for adult survivors of child maltreatment and 8 studies that measured quality-of-life for pediatric injury not related to child maltreatment. No study reported quality-of-life values for children younger than age 3.</p> <p>Currently available preference-based QOL instruments (EQ-5D, HUI, QWB, SF-6D) have been developed primarily for adults with the exception of the Health Utilities Index. These instruments do not include many of the domains identified as being important in capturing changes in quality of life for child maltreatment, such as potential for growth and development or psychological sequelae specific to maltreatment.</p> <p>Conclusion</p> <p>Recommendations for valuing preference-based quality-of-life for child maltreatment will vary by developmental level and type of maltreatment. In the short-term, available multi-attribute utility instruments should be considered in the context of the type of child maltreatment being measured. However, if relevant domains are not included in existing instruments or if valuing health for children less than 6 years of age, direct valuation with a proxy respondent is recommended. The choice of a proxy respondent is not clear in the case of child maltreatment since the parent may not be a suitable proxy. Adult survivors should be considered as appropriate proxies. Longer-term research should focus on identifying the key domains for measuring child health and the development of preference-based quality-of-life instruments that are appropriate for valuing child maltreatment outcomes.</p

A Comparison of Willingness to Pay to Prevent Child Maltreatment Deaths in Ecuador and the United States

Estimating the benefits of preventing child maltreatment (CM) is essential for policy makers to determine whether there are significant returns on investment from interventions to prevent CM. The aim of this study was to estimate the benefits of preventing CM deaths in an Ecuadorian population, and to compare the results to a similar study in a US population. The study used the contingent valuation method to elicit respondents’ willingness to pay (WTP) for a 1 in 100,000 reduction in the risk of CM mortality. After adjusting for differences in purchasing power, the WTP to prevent the CM mortality risk reduction in the Ecuador population was $237 and the WTP for the same risk reduction in the US population was$175. In the pooled analysis, WTP for a reduction in CM mortality was significantly impacted by country (p = 0.03), history of CM (p = 0.007), payment mechanism (p < 0.001), confidence in response (p = 0.014), and appropriateness of the payment mechanism (p < 0.001). These findings suggest that estimating benefits from one culture may not be transferable to another, and that low- and middle-income countries, such as Ecuador, may be better served by developing their own benefits estimates for use in future benefit-cost analyses of interventions designed to prevent CM

A Comparison of Willingness to Pay to Prevent Child Maltreatment Deaths in Ecuador and the United States

Estimating the benefits of preventing child maltreatment (CM) is essential for policy makers to determine whether there are significant returns on investment from interventions to prevent CM. The aim of this study was to estimate the benefits of preventing CM deaths in an Ecuadorian population, and to compare the results to a similar study in a US population. The study used the contingent valuation method to elicit respondents’ willingness to pay (WTP) for a 1 in 100,000 reduction in the risk of CM mortality. After adjusting for differences in purchasing power, the WTP to prevent the CM mortality risk reduction in the Ecuador population was $237 and the WTP for the same risk reduction in the US population was$175. In the pooled analysis, WTP for a reduction in CM mortality was significantly impacted by country (p = 0.03), history of CM (p = 0.007), payment mechanism (p &lt; 0.001), confidence in response (p = 0.014), and appropriateness of the payment mechanism (p &lt; 0.001). These findings suggest that estimating benefits from one culture may not be transferable to another, and that low- and middle-income countries, such as Ecuador, may be better served by developing their own benefits estimates for use in future benefit-cost analyses of interventions designed to prevent CM

Predictors of Engagement in a Parenting Intervention Designed to Prevent Child Maltreatment

Objective: The objectives of this analysis were to: 1) assess the impact of sociodemographic factors, and perceived costs and benefits on engagement in a parenting program designed to prevent child maltreatment, 2) determine if perceived costs and benefits mediated the association between sociodemographic factors and engagement, and 3) assess whether or not race/ethnicity moderated the relationship between sociodemographic factors, perceived costs and benefits, and engagement.Methods: Perceived costs and benefits of the intervention were assessed from parents providing self-reports, including satisfaction/ usefulness of the program (benefits), and time/difficulty associated with the program (costs). Engagement was defined as attendance at both the mid-point and then the number of visits attended throughout the remainder of the intervention. To investigate the direct and indirect effects (through perceived costs and benefits) of parental sociodemographic factors (education, age, gender, number of children, household income) on program engagement, data were analyzed with structural equation modeling (SEM). To assess the potential moderating effect of race/ethnicity, separate models were tested for White and African-American parents.Results: Perceived benefits positively impacted attendance for both White (n=227) and African-American (n=141) parents, whereas perceived costs negatively influenced attendance only for White parents. Parent education and age directly impacted attendance for White parents, but no sociodemographic factor directly impacted attendance for African-American parents. The indirect impact of sociodemographic characteristics on attendance through perceived costs and perceived benefits differed by race/ethnicity.Conclusions: Results suggest that White parents participate in a parenting program designed to prevent child maltreatment differently based upon their perceived benefits and costs of the program, and based on benefits only for African-American parents. Parental perception of costs and/or benefits of a program may threaten the effectiveness of interventions to prevent child maltreatment for certain racial/ethnic groups, as it keeps them from fully engaging in empirically validated programs. Different methods may be required to retain participation in violence prevention programs depending upon race/ethnicity

Predictors of Engagement in a Parenting Intervention Designed to Prevent Child Maltreatment

Objective: The objectives of this analysis were to: 1) assess the impact of sociodemographic factors, and perceived costs and benefits on engagement in a parenting program designed to prevent child maltreatment, 2) determine if perceived costs and benefits mediated the association between sociodemographic factors and engagement, and 3) assess whether or not race/ethnicity moderated the relationship between sociodemographic factors, perceived costs and benefits, and engagement.Methods: Perceived costs and benefits of the intervention were assessed from parents providing self-reports, including satisfaction/ usefulness of the program (benefits), and time/difficulty associated with the program (costs). Engagement was defined as attendance at both the mid-point and then the number of visits attended throughout the remainder of the intervention. To investigate the direct and indirect effects (through perceived costs and benefits) of parental sociodemographic factors (education, age, gender, number of children, household income) on program engagement, data were analyzed with structural equation modeling (SEM). To assess the potential moderating effect of race/ethnicity, separate models were tested for White and African-American parents.Results: Perceived benefits positively impacted attendance for both White (n=227) and African-American (n=141) parents, whereas perceived costs negatively influenced attendance only for White parents. Parent education and age directly impacted attendance for White parents, but no sociodemographic factor directly impacted attendance for African-American parents. The indirect impact of sociodemographic characteristics on attendance through perceived costs and perceived benefits differed by race/ethnicity.Conclusions: Results suggest that White parents participate in a parenting program designed to prevent child maltreatment differently based upon their perceived benefits and costs of the program, and based on benefits only for African-American parents. Parental perception of costs and/or benefits of a program may threaten the effectiveness of interventions to prevent child maltreatment for certain racial/ethnic groups, as it keeps them from fully engaging in empirically validated programs. Different methods may be required to retain participation in violence prevention programs depending upon race/ethnicity