Determining the cost effectiveness of a smoke alarm give-away program using data from a randomized controlled trial

Area of Science:

• Public Health
• Health Economics
• Fire Safety Engineering

Background:

• Domestic fires in the UK and US cause significant fatalities, injuries, and economic losses annually.
• In 2001, UK domestic fires resulted in 486 deaths and 17,300 injuries, with property loss estimated at £375 million.
• US home fires in 2001 caused 3110 deaths, 15,200 injuries, and $5.5 billion in direct property damage.

Purpose of the Study:

• To evaluate the effectiveness and cost-effectiveness of a smoke alarm giveaway program in an inner-city UK population.
• To determine if distributing smoke alarms reduces fire-related deaths and injuries.

Main Methods:

• A cluster randomized controlled trial (RCT) was conducted with 40 areas randomized to either a smoke alarm giveaway or control group.
• Data on fire-related deaths, injuries, and fires were prospectively collected for each ward.
• Cost-effectiveness analysis incorporated damage, fire service, healthcare, and giveaway program costs, using analytical methods suitable for cluster designs and zero-inflated data.

Main Results:

• Households in giveaway wards incurred a mean cost of £12.76, compared to £10.74 in control wards.
• Intervention wards experienced a higher mean number of deaths and injuries (6.45) than control wards (5.17).
• The probability of the smoke alarm giveaway being cost-effective was 0.15 when valuing an avoided injury/death at £1000.

Conclusions:

• The smoke alarm giveaway program, as implemented in this trial, is unlikely to be a cost-effective use of resources.
• The findings suggest that this specific intervention strategy may not be optimal for reducing fire-related harm in the studied population.