Abstract
OBJECTIVE: To determine the cost effectiveness of a public health legislative/educational strategy to reduce tap water scalds in children less than 10 years of age. DESIGN: Cost-effectiveness analysis conducted from the government perspective over a 10-year time horizon. POPULATION: Children under 10 years of age in Ontario, Canada INTERVENTIONS: Legislation to set thermostat settings on new domestic water heaters to lower temperatures (maximum 49 degrees C) plus annual educational notices to utility customers versus status quo. MAIN OUTCOME MEASURES: The burden of tap water scalds, healthcare resource utilization, the cost and effectiveness of the proposed intervention, and the probabilities assigned to health outcomes were modeled in a decision analysis based on population-based data, patient charts, and the published medical literature. All costs and health outcomes beyond 1 year were discounted at 3%. RESULTS: An estimated 182 children under 10 require medical care for tap water scald injuries annually in Ontario (13.98 per 100,000). Of these, 65 require emergency department (ED) care only (median cost $C149 per injury), 103 require ED care with clinic follow-up ($C577 per injury), 14 require hospital admission ($C5203 per injury), and two require surgical skin grafting ($C28,526 per injury). The estimated cost of the intervention was $C51,000 annually, with a projected 56% reduction in tap water scald injuries. Over 10 years, the intervention group would show total costs of $C1.17 million and 704 scalds, compared with $C1.65 million and 1599 scalds in the status quo group. Therefore, the intervention would be cost saving, with an incremental ratio of $C531 saved per scald averted. Sensitivity analyses showed that the intervention would remain cost saving through a wide range of variable estimates. CONCLUSIONS: Legislation to lower thermostat settings on domestic water heaters plus annual educational notices to utility customers would generate cost savings while reducing the morbidity from tap water scalds in children.