Abstract
The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.
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References
Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth. Olympia, WA: Washington State Institute for Public Policy.
Chatterji, P., Caffray, C. M., Jones, A. S., Lillie-Blanton, M., & Werthamer, L. (2001). Applying cost analysis methods to school-based prevention programs. Prevention Science, 2(1), 45–55.
Cisler, R., Holder, H. D., Longabaugh, R., Stout, R. L., & Zweben, A. (1998). Actual and estimated replication costs for alcohol treatment modalities: Case study from project match. Journal of Studies on Alcohol, 59(5), 503–512.
Crowley, D. M., Jones, D. E., Greenberg, M. T., Feinberg, M. E., & Spoth, R. L. (2012). Resource consumption of a diffusion model for prevention programs: The prosper delivery system. Journal of Adolescent Health, 50(3), 256–263.
Foster, E. M., Dodge, K. A., & Jones, D. E. (2003). Issues in the economic evaluation of prevention programs. Applied Developmental Science, 7(2), 76–86.
Ginexi, E. M., & Hilton, T. F. (2006). What’s next for translation research? Evaluation and the Health Professions, 29(3), 334–347.
Glazner, J., Bondy, J., Luckey, D., & Olds, D. (2004). Final report to the administration for children and families: Effect of the nurse family partnership on government expenditures for vulnerable first-time mothers and their children in Elmira, New York, Memphis, Tennessee, and Denver, Colorado (#90XP0017). Washington, DC: Administration for Children and Families, Office of Planning, Research and Evaluation.
Gold, M. R., Siegel, J. E., Russell, L. B., & Weinstein, M. C. (Eds.). (1996). Cost-effectiveness in health and medicine: Report of the panel on cost-effectiveness in health and medicine. New York, NY: Oxford University Press.
Kitzman, H., Olds, D. L., Henderson Jr, C. R., Hanks, C., Cole, R., Tatelbaum, R., …, Barnard, K. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial. Journal of the American Medical Association, 278(8), 644–652.
Korfmacher, J., O’Brien, R., Hiatt, S., & Olds, D. L. (1999). Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: A randomized trial. American Journal of Public Health, 89(12), 1847–1851.
Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M., & Anderson, L. (2012). Return on investment: Evidence-based options to improve statewide outcomes. Olympia: Washington State Institute for Public Policy.
Miller, T. R., & Levy, D. T. (2000). Cost-outcome analysis in injury prevention and control: Eighty-four recent estimates for the United States. Medical Care, 38(6), 562–582.
Miller, T. R., Olds, D., Knudtson, M., Luckey, D., Bondy, J., & Stevenson, A. (2010). Return on investment: Nurse and paraprofessional home visitation. (Grant Number: 2005-MU-MU-0001). U.S. Department of Justice. Denver: University of Colorado Health Sciences Center.
NFP National Services Office. (2013). Quarterly report for national nfp: Data through 31 Dec 2012. Denver: Nurse-Family Partnership National Services Office.
O’Brien, R. A., Moritz, P., Luckey, D. W., McClatchey, M. W., Ingoldsby, E. M., & Olds, D. L. (2012). Mixed methods analysis of participant attrition in the nurse-family partnership. Prevention Science, 13(3), 219–228.
Olds, D., Donelan-McCall, N., O’Brien, R., MacMillan, H., Jack, S., Jenkins, T., & Beeber, L. (2013). Improving the nurse-family partnership in community practice. Pediatrics, 132(Suppl 2), S110–S117.
Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., & Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278(8), 637–643.
Olds, D. L., Henderson, C. R, Jr, Phelps, C., Kitzman, H., & Hanks, C. (1993). Effect of prenatal and infancy nurse home visitation on government spending. Medical Care, 31(2), 155–174.
Suter, C. R. (2010). Economic evaluation of a community-based, family skills prevention program (M.A. Thesis), Washington State University. Retrieved from http://www.dissertations.wsu.edu/Thesis/Spring2010/c_suter_042010.pdf
U.S. Bureau of Labor Statistics. (2011). Occupation employment statistics (oes data—state).
U.S. Bureau of Labor Statistics. (2013). Employment cost index—historical listing, volumes i and iii. Retrieved from www.bls.gov/ect/#tables
Acknowledgments
National Institute on Drug and Alcohol Abuse (NIDA) Grant 1-R01 DA021624 partially funded this work. Thanks to David Olds, six state NFP programs, and the NFP National Services Office for supplying unpublished data and answering questions. We thank Tamar Bauer, Sandy Dunlap, Karen Kalaijian, other staff of the NFP National Services Office, and David Olds for their extremely helpful comments. The views expressed are those of the authors and do not necessarily reflect the funder’s or reviewers’ views.
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Ted R. Miller declares that although he has received consulting fees from the Nurse-Family Partnership National Services Office for economic analysis support, he has no conflict of interest in regards to this article.
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Miller, T.R., Hendrie, D. Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up. J Primary Prevent 36, 419–425 (2015). https://doi.org/10.1007/s10935-015-0406-3
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DOI: https://doi.org/10.1007/s10935-015-0406-3