Cost-Effectiveness of Identification and Referral to Improve Safety (IRIS), a Domestic Violence Training and Support Programme for Primary Care: a Modelling Study Based on a Randomised Controlled Trial

Abstract

Objective: The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention.Design: Markov model-based cost-effectiveness analysis.Setting: General practices in two urban areas in the UK.Participants: Simulated female individuals from the general UK population who were registered at general practices, aged 16 years and older.Intervention: General practices received staff training, prompts to ask women about DV embedded in theelectronic medical record, a care pathway including referral to a specialist DV agency and continuingcontact from that agency. The trial compared the rate of referrals of women with specialist DV agencies from 24 general practices that received the IRIS programme with 24 general practices not receiving theprogramme. The trial did not measure outcomes for women beyond the intermediate outcome of referral to specialist agencies. The Markov model extrapolated the trial results to estimate the long-term healthcare and societal costs and benefits using data from other trials and epidemiological studies.Results: The intervention would produce societal cost savings per woman registered in the general practice of UK£37 (95% CI £178 saved to a cost of £136) over 1 year. The incremental quality-adjusted life-year was estimated to be 0.0010 (95% CI - 0.0157 to 0.0101) per woman. Probabilistic sensitivity analysis found 78% of model replications under a willingness to pay threshold of £20 000 per quality-adjusted life-year.Conclusions: The IRIS programme is likely to be costeffective and possibly cost saving from a societalperspective. Better data on the trajectory of abuse and the effect of advocacy are needed for a more robust model.