Preventing Deaths and Injuries from House Fires: A Cost-Benefit Analysis of a Community-based

Smoke Alarm Installation Program

Safe States 2017 Annual MeetingSeptember 12, 2017

Aurora, CO Slide 1

The Injury Prevention Center of Greater Dallas

(IPC) was established in 1994

to implement proven, effective

primary prevention strategies.1

1 Injury Prevention of Greater Dallas. Home Page. http://www.injurypreventioncenter.org/

Slide 2

• Use data to drive strategies

• Collaborate with the community

• Use evidence-informed strategies

• Evaluate all interventions

International Safe Communities Criteria

Define the Problem

Identify Groups at

Risk

Implement Proven

Strategies

Evaluate Strategies

Injury Prevention Center Guiding Principles1

Slide 3

The Facts

2 Haynes H. Fire Loss in the United States During 2015. Quincy, Massachusetts: National Fire Protection Association, 20163 Ahrens M. Smoke Alarms in U.S. Home Fires. Quincy, Massachusetts: National Fire Protection Association, 2015

• In 2015, there were 270,500 fires in one- and two-family homes, resulting in 2,155 deaths and 8,050 non-fatal injuries.2

– Represents 66% of total fire deaths and 51% of total fire injuries

• In house fires reported to U.S. fire departments from 2009-2013, only 53% of the houses had a functional smoke alarm that sounded at the time of the fire.3

• A functioning smoke alarm reduces the risk of dying by 50%.3

Slide 4

Background → Operation Installation (OI)• An ongoing community-based smoke alarm installation

program since 1999.4,5

• Teams of firefighters (Dallas Fire-Rescue) and volunteers canvas neighborhoods and go door-to-door to install smoke alarms.

• 36 high-risk census tracts in Dallas, TX are targeted.6

• 10 year effectiveness study (2001-2011)4:– 63% lower house fire death and injury rate in program homes vs

non-program homes (3.1 / 100,000 vs 9.6 / 100,000, respectively)

Aim of this Study7 → To conduct a retrospective cost-benefit analysis of OI, comparing the program’s costs to its effectiveness in

preventing deaths and injuries

4 Istre GR, McCoy MA, Moore BJ, et al. Preventing deaths and injuries from house fires: an outcome evaluation of a community-based smoke alarm installation programme. Inj Prev 2014;20:97–102.5 Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residentialfire-related injuries. N Engl J Med 1996;335:27–31.6 Istre GR, McCoy MA, Osborn L, et al. Deaths and injuries from house fires. N Engl J Med 2001;344:1911–16.7 Yellman MA, Peterson C, McCoy MA, Stephens-Stidham S, Caton E, Barnard JJ, Padgett TO, Florence C, Istre GR. Preventing deaths and injuries from house fires: a cost–benefit analysis of a community-based smoke alarm installation programme. Injury prevention. 2017 Feb 9:injuryprev-2016. Slide 5

$723,436 51%$482,007

34%

$189,068 13%

$29,908 2%

Cost Type

Personnel Supplies

Materials Transportation

*Costs presented as 2013 US dollars.8 US Bureau of Labor Statistics. Consumer Price Index—All Urban Consumers, U.S. city average (Series ID: CUUR0000SA0,CUUS0000SA0) 2016. http://www.bls.gov/cpi/data.htm

Total Cost of Program →

$1,483,618

Cost per Smoke Alarm Installed →

$1,483,618 / 25,068 =

$59.18

# of Smoke Alarms Installed →

25,068

Operation Installation Program Costs8* (2006-2012)

Slide 6

• Cost observation period (2006-2012) was different than effectiveness study period (2001-2011).

Estimated Cost of OI for 10-year Effectiveness Study Time Period →

$59.18 * 20,127 =

$1,191,192

(note: numbers are slightly different due to rounding)

Estimated Cost of OI (2001-2011)

Slide 7

Cost of Medical CareUnit Cost9 With Program

Without Program

Non-fatal Injuries

Treated in ED $1,846 $1,846 $4,199

Admitted to Hospital

$31,076 $31,076 $70,680

Total (non-fatal) $32,922 $74,878

Fatal Injuries $12,791 $25,582 $99,744

Total Medical Care Costs

$58,504 $174,623

Slide 8

9 US Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS), Cost of Injury Reports 2010, Nonfatal Hospitalized Injuries, Both Sexes, All Ages, United States, 2010 [cited 2017 September 11]. http://www.cdc.gov/injury/wisqars/index.html

Ex: Injuries treated in ED for non-program population:

2.3 * $1,846 = $4,199

Cost of Lost ProductivityUnit Cost9 With Program

Without Program

Non-fatal Injuries

Treated in ED $3,863 $3,863 $8,786

Admitted to Hospital

$37,684 $37,684 $85,709

Total (non-fatal) $41,547 $94,495

Fatal Injuries $835,288 $1,670,576 $6,513,577

Total Lost Productivity Costs

$1,712,123 $6,608,072

Slide 9

Total CostProgram

CostsMedical

Care CostsLost

ProductivityTotal

Payer Perspective

With Program $1,191,192 $58,504 ---- $1,249,696

Without Program

$0 $174,623 ---- $174,623

Societal Perspective

With Program $1,191,192 $58,504 $1,712,123 $2,961,819

Without Program

$0 $174,623 $6,608,072 $6,782,694

Slide 10

Results (Continued)• From a Payer Perspective:

– The incremental cost per fatal/non-fatal injury averted was $128,800.

• From a Societal Perspective:– The incremental cost per fatal/non-fatal injury averted

was -$457,763.– OI is estimated to have saved $3.8 million.– Every $1 spent on OI yielded $3.21 in averted lifetime

costs.– Program costs could have been over 4 times higher

(nearly $250 per smoke alarm installed) or program effectiveness could have been reduced by over 75%, and OI still would have been cost saving.

Slide 11

• Comparing the costs and consequences of an intervention to determine “…whether an intervention is an efficient use of society’s resources.”10

• Why?– To demonstrate the monetary value of your

prevention program– Relevant for making decisions about whether or not

the implementation of a particular public health program or intervention is worth the financial investment, from an economic perspective

10 Dufour A, Bartram J, editors. Animal waste, water quality and human health. Chaper 12. IWA Publishing; 2012 Oct 14.

Economic Evaluation (“Costing Studies”)

Slide 12

Common Types of Economic Evaluation11

11 National Center for Chronic Disease Prevention and Health Promotion. Five-Part Webcast on Economic Evaluation. Atlanta, GA: Centers for Disease Control and Prevention. [cited 10 Sept 2017]. https://www.cdc.gov/dhdsp/evaluation_resources/economic_evaluation/.

• Cost-Benefit Analysis (CBA) → – All costs and outcomes are converted into dollar

terms

• Cost-Effectiveness Analysis (CEA) →– Outcomes are natural health units rather than dollar

amounts (Ex: number of lives saved).– Usually used to compare two different interventions

aimed at the same health outcome

• Cost-Utility Analysis (CUA) → – Similar to CEA but combines length of life and quality

of life (QALYs or DALYs)

Slide 13

Which Type of Economic Analysis Should I Use?12

12 Gray A. Economic Evaluation. In: Dawes, et al. Eds. Evidence Based Practice: A Primer for Health Care Professionals. 2001.

Slide 14

• By using detailed program costs and observed reductions in fire deaths and injuries from a 10-year effectiveness study of Operation Installation, this study supports previous findings that these programs can be cost saving (a positive return on investment).

• Economic analyses such as these provide a unique tool for decision makers within and outside the field of public health.

Conclusions

Slide 15

1 Injury Prevention of Greater Dallas. Home Page. http://www.injurypreventioncenter.org/

2 Haynes H. Fire Loss in the United States During 2015. Quincy, Massachusetts: National Fire Protection Association, 2016

3 Ahrens M. Smoke Alarms in U.S. Home Fires. Quincy, Massachusetts: National Fire Protection Association, 2015

4 Istre GR, McCoy MA, Moore BJ, et al. Preventing deaths and injuries from house fires: an outcome evaluation of a community-based smoke alarm installation programme. Inj Prev 2014;20:97–102.

5 Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residential fire-related injuries. N Engl J Med 1996;335:27–31.

6 Istre GR, McCoy MA, Osborn L, et al. Deaths and injuries from house fires. N Engl J Med 2001;344:1911–16.

7 Yellman MA, Peterson C, McCoy MA, Stephens-Stidham S, Caton E, Barnard JJ, Padgett TO, Florence C, Istre GR. Preventing deaths and injuries from house fires: a cost–benefit analysis of a community-based smoke alarm installation programme. Injury prevention. 2017 Feb 9:injuryprev-2016.

8 US Bureau of Labor Statistics. Consumer Price Index—All Urban Consumers, U.S. city average (Series ID: CUUR0000SA0,CUUS0000SA0) 2016. http://www.bls.gov/cpi/data.htm

9 US Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS), Cost of Injury Reports 2010, Nonfatal Hospitalized Injuries, Both Sexes, All Ages, United States, 2010 [cited 2017 September 11]. http://www.cdc.gov/injury/wisqars/index.html

10 Dufour A, Bartram J, editors. Animal waste, water quality and human health. Chaper 12. IWA Publishing; 2012 Oct 14.

11 National Center for Chronic Disease Prevention and Health Promotion. Five-Part Webcast on Economic Evaluation. Atlanta, GA: Centers for Disease Control and Prevention. [cited 10 Sept 2017]. https://www.cdc.gov/dhdsp/evaluation_resources/economic_evaluation/.

12 Gray A. Economic Evaluation. In: Dawes, et al. Eds. Evidence Based Practice: A Primer for Health Care Professionals. 2001

List of Resources

Slide 16

Acknowledgments• Thank you to the following individuals and groups:

– Cora Peterson

– Curtis Florence

– The Dallas Fire-Rescue Department

Slide 17

Merissa Yellmanmyellman18@gmail.com

Shelli Stephens-StidhamShelli.stidham@phhs.org

Mary A. McCoyEmily Caton

Jeffrey J. BarnardTed O. Padgett Jr.Gregory R. Istre

Slide 18