Nurse-led hospital violence intervention programme versus standard care in Wales: a cost-effectiveness analysis

Violence is a major public health issue. In the United Kingdom (UK), injuries resulting from interpersonal violence were estimated to cost the National Health Service (NHS) £2.9 billion annually. Hospital Violence Intervention Programmes (HVIPs), based in Emergency Departments (EDs), identify individuals (both perpetrators and victims) who may benefit from support for modifiable risk factors associated with exposure to violence. In this study we evaluate the cost-effectiveness of implementing an HVIP called the Violence Prevention Team (VPT) relative to standard care in Wales.

We conducted a cost-effectiveness analysis of VPTs in ED relative to standard care. We included patients aged 11 years or older who attended ED with an assault-related injury between November 2019 and February 2024 in Wales. Participants exposed to the VPT or standard care were matched with a minimum 1:1 ratio. A hybrid decision tree-Markov model was created to follow patients attending ED for an initial assault-related attendance and to track any subsequent unplanned ED visits thereafter. Health outcomes were measured in quality-adjusted life years (QALYs), and costs (in 2023/2024 British pounds sterling) were estimated using a (a) health perspective and (b) societal perspective (including additional costs across the third sector) over a time horizon of 10 years. Routine data from the Secure Anonymised Information Linkage (SAIL) databank were used to inform model probability and healthcare cost estimates. QALYs were estimated using the literature. We estimated the incremental cost-effectiveness ratio (ICER), net monetary and net health benefits, and probability of being cost-decreasing and QALY-increasing. ICERs were interpreted against the UK Department for Health's cost effectiveness threshold of £15,000 per QALY and the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20,000-£30,000 per QALY. This study is registered with ISRCTN (68945844).

Our base case analysis suggested that implementing VPTs in ED was cost-saving and more effective relative to standard care, from both a health and societal perspective. At a NICE cost-effectiveness threshold of £20,000-£30,000 per QALY, there was 83% probability that VPTs in ED are considered cost-effective relative to standard care. At a threshold of £15,000 per QALY, the probability that VPTs in ED are considered cost-effective relative to standard care was 84%. When only including ED and associated inpatient admission costs and excluding primary care visit costs, VPTs remained cost-effective from a health perspective (£12,950 per QALY gained).

VPTs in ED are strategically placed to intervene following injuries. They have the potential to reduce costs and improve health outcomes, and their implementation should be prioritised by the NHS.

This study was funded by the National Institute for Health and Care Research, Public Health Research Board (NIHR134055).