by Tracey Young, Paul Tappenden, Mike Gillett, Rasiah Thayakaran, Rachel Armitage, Sara Morgan
Background
Domestic violence and abuse is a significant issue associated with various health problems and financial difficulties, affecting mostly women. Project CARA addresses this by offering workshops to first-time offenders, focusing on raising awareness and improving safety for families, and has shown promising results in reducing re-arrests.
What did we aim to do?
We examined whether Project CARA was cost-effective using a cost per reoffence avoided and a cost per quality adjusted life tear (QALY) approach.
How we did it?
This study examined the effectiveness and costs of Project CARA across eight police force areas by comparing data before and after its implementation. Information on domestic abuse arrests, the cost of mobilisation and the ongoing delivery of CARA were obtained. The analysis evaluates CARA’s impact on the health and social care system, the criminal justice system, and the victims over a one-year time frame. Results were analysed separately for each police force area.
What did we find?
In three police force areas, the risk of domestic abuse reoffending increased which showed CARA to be less effective and more costly. However, for other police force areas the risk of domestic abuse reoffending was reduced and depending on the willingness to pay of the decision maker, suggested CARA could be cost effective (The incremental cost per reoffence avoided ranged from £570 to £47,000 per domestic abuse reoffence avoided).
The incremental QALY gained from CARA was very small (0.0001) so when estimating the incremental cost per quality adjusted life years gained, we got very large values ranging from -£180m to £480m suggesting CARA was not cost-effective.
What does this mean?
While this analysis presents cost per QALY results, it acknowledges limitations because the costs include factors beyond healthcare, and the QALYs only consider the victim’s health, not broader impacts. Therefore, an alternative framework focusing on the cost per reoffence avoided is also presented to account for these uncertainties. Using this alternative approach, if the number of DA reoffences is reduced post CARA then CARA could be cost-effective, depending on the willingness to pay to further reduce DA reoffences.
Funding
This work was supported by National Institute for Health Research Applied Research Collaboration (ARC) North East and North Cumbria (NIHR NENC) as part of the Health inequalities Consortium.