IRISi is a social enterprise committed to improving the healthcare response to gender-based violence through health and specialist services working together. In 2021, IRISi’s “16 Days of Activism against Gender-Based Violence” campaign is themed as, “16 ways for the 16 days of action: how health care settings can improve their response to Violence Against Women and Girls”. Our aim is to reinforce that health care professionals have an undeniable and fundamental role in identifying victims and perpetrators so we can end violence against women and girls.
It is increasingly important that local IRIS sites are able to demonstrate to commissioning organisations, in financial terms, the health benefits of the work they have done so that IRIS continues to be sustained into the future. The IRIS cost-effectiveness analysis tool has been created to help local sites to do this and it has been just launched as part of IRISi’s “16 days campaign”.
During an online session led by Dr Estela Barbosa, Data Scientist at IRISi and developer of the CEA Tool, all participants were introduced to the tool and how to fill in the data from their own sites to produce the cost-effectiveness measures automatically.
“The IRIS Programme is proven to be a cost-effective intervention to improve the general practice response to domestic abuse, with a cost effectiveness analysis conducted during the randomised controlled trial and again in a ‘real world’ setting in six IRIS sites. Although this national evidence base has existed for many years, we know that IRIS Partners and commissioners are frequently under pressure to demonstrate the cost effectiveness of their local IRIS service. We have developed a tool to enable them to do this”, explains Dr Barbosa.
Gill Smallwood, Chief Executive at Fortalice in Bolton, and Dr Clare Ronalds, FRCGP, former Clinical Lead in Manchester, were also panellists in the event since both were involved in piloting and refining the CEA tool. Fortalice was the partner organisation first invited to test the CEA Tool: “The tool assists with some aspects of added value for commissioning”, reinforces Gill Smallwood.
“In Manchester we trialled the updated IRISi Cost Effectiveness Analysis template using data and real-life costs for a year 2019-2020. The results show Manchester Women’s Aid IRIS programme is highly cost-effective, cost-neutral for the NHS, and cost-saving when combined with societal savings.”, explains Dr Clare Ronalds.
What data is needed for the CEA?
All the modelling is done behind the scenes on the excel spreadsheet file, to calculate the figures shown on the results pages. In order to do that, the CEA tool has a page with a number of pieces of data to enter including:
- Number of women aged 16 or over, registered in IRIS trained practices.
- Number of women aged 16 or over in non-IRIS practices in locality – Data available from NHS Digital.
- Number of women referred to IRIS for first time in a year – standard IRIS data collected.
- Number of women referred with whom contact made – standard IRIS data collected.
- Number of o. women referred to non-IRIS DVA services in locality (e.g. non-IRIS DVA agencies, MARAC, IDVA services) by non-IRIS trained practices.
- Total local IRIS programme budget for year.
- Prevalence of DVA in locality – from Crime Survey England and Wales.
- Cost of onward referral based on average contact time – use IRIS trial data.
Interpreting the results
We know from previously published studies that the IRIS programme, when implemented, improves the quality of life of the women it supports. This cost-effectiveness exercise looks at how costs and quality of life improvements are related. Results are presented from two cost perspectives: the NHS perspective and the societal perspective.
Put simply, the NHS perspective takes into account change in healthcare system (NHS) costs as a result of the IRIS programme – for example, any change in how often service users visit their GP or attend A&E or need hospital treatment, or how many prescriptions they require.
The societal perspective takes a wider view considering how the IRIS programme affects costs to the healthcare system, the legal system (civil and criminal), costs of housing, social care, personal costs, costs of specialised services and loss of productivity due to days lost at work.
“Cost Effectiveness Analysis is so important as it demonstrates to the NHS and other IRIS commissioners the value for money that IRIS offers, and provides evidence that it is highly cost-effective, virtually cost neutral to the NHS, and with combined NHS and societal costs, it saves money.
The CEA contributes to our IRIS funding review. Our IRIS Steering Group Chair said: ‘The CEA was really useful to demonstrate the cost effectiveness of the IRIS service and why commissioners could be confident to reinvest in the service. It explained that we were investing to save’”, affirms Dr Clare Ronalds.
The CEA Tool is available to all IRIS sites and it will be delivered to each one of them by our Regional Managers from IRISi. “The IRIS CEA tool should enable each local IRIS site to provide its funders with real life, locally relevant results. It should be helpful when building business cases for further funding or recommissioning” said Dr Estela Barbosa in her concluding remarks at the CEA event.
Numbers to have in mind
- The estimated cost of domestic violence and abuse, including physical and mental health costs, is £ 66 billion per year (Home Office, 2019);
- Most recent research shows that the IRIS programme is sustainable and that practices with IRIS are 30 times more likely to make a referral to specialist support for their patients than those without IRIS (Panovska-Griffiths et al, 2020);
- The cost effectiveness of the model was assessed in this study and it found that the IRIS programme saved £14 for each woman aged 16 or older registered in the IRIS trained general practice (Barbosa et al, 2018); the same study shows an increase in quality of life for each woman affected by domestic abuse;
- The IRIS programme is therefore cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective (NHS perspective) (Barbosa et al, 2018).
At IRISi, we understand we work in partnership. This means that while we are keen for your network to use the CEA tool autonomously, we are happy to be involved in the process. If you are an IRIS service requiring support on running your local cost-effectiveness analysis, please get in touch with your Regional Manager or email us at email@example.com.