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A Return-On-Investment Analysis for Lead Poisoning Case Management in New York City
Jason C Goldwater1, Yael M Harris, Kyle W Neustrom
1Author Affiliations: Laurel Health Advisors, LLC, Maryland (Goldwater, and Harris); and New York City Department of Health and Mental Hygiene, New York (Neustrom, Sedlar, Ehrlich, and Faciano).
Objectives:
To evaluate the return on investment (ROI) and social return on investment (SROI) of childhood lead poisoning case management in New York City by quantifying direct cost savings and long-term societal benefits associated with intervention among children with elevated blood lead levels.
Design:
Mixed-methods economic modeling study estimating ROI and SROI using program cost data, published outcome valuations, and sensitivity analyses for 1462 high-risk NYC children.
Setting:
New York City Department of Health-led lead poisoning case management program serving high-risk children in urban housing.
Participants:
One thousand four hundred sixty two New York City children with blood lead levels ≥10 μg/dL who received case management and environmental inspections.
Intervention:
Public health nurse-led case management, including home inspections, lead hazard remediation coordination, medical monitoring, and family support services.
Main Outcome Measure:
ROI and SROI, including avoided medical, education, productivity, justice, and quality-of-life costs.
Results:
Baseline ROI was 1.34 ($2.34 saved per $1 invested); SROI was 26.37, reflecting more than $98 million in lifetime societal benefits for the full cohort of 1462 children.
Conclusions:
Lead poisoning case management generates substantial economic and societal returns, supporting sustained investment as a high-impact, equity-focused public health strategy.
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