Framework for estimating the benefits associated with averting a case of childhood physical or emotional abuse, from a societal perspective
| Category of benefit | Rationale | Data source | Saving per case of abuse averted* (US$) | |
| Physical | Emotional | |||
| Direct saving | ||||
| Health service use | Costs associated with immediate injuries | Amount attributable to abuse unknown for SA | – | – |
| Social service use | Costs associated with investigation and immediate response to an abuse case | Social worker time approximated from current wages and norms set by Barberton’s costing of SA social care bill, assumes all cases are investigated appropriately39 | 553† | |
| Child care and court costs | Costs associated with processing and supporting a child in foster care, the outcome of most severe abuse cases in SA | Total child welfare bill was ZAR 1.58 billion in 2015, but proportion attributable to physical or emotional abuse unknown | – | – |
| Indirect saving | ||||
| DALYs averted | Lifetime costs associated with attributable increased risk of mental health problems, substance abuse and STIs | Fang et al12 (which assumes that the monetary value of one DALY is equivalent to a country’s GDP per capita), approximated to case level using prevalence from Burton et al11 | 1682 | 1929 |
| Long-term health service use | Costs associated with use of health service associated with mental health problems, substance abuse and STIs | Amount attributable to abuse unknown for SA | – | – |
| Productivity loss | Estimated value of individual productivity loss for a victim of abuse due to long-term health impacts | Fang et al,12 approximated to case level using prevalence from Burton et al11 | 408 | 322 |
| Delinquency/criminal system | Victims of childhood abuse are more likely to become criminals incurring costs to the criminal system | Unknown for SA, but form a considerable proportion of the savings attributable to parenting programmes in HICs26 | – | – |
| Intergenerational costs | Victims of childhood abuse are more likely to become the perpetrators of abuse, incurring costs through several generations. | Proportion of victims that become perpetrators unknown for SA6 | – | – |
| Total saving per case averted | 2644 | 2804 | ||
*All costs presented in 2015, nominal US dollars, to allow direct comparison with the costs of programme implementation.
†As this is a strong assumption for the SA context, we conducted sensitivity analysis of total savings, making an alternative assumption that only 20% of cases are fully investigated. This results in a reduction in the total saving per case averted to US$2201 and US$2361 for physical and emotional abuse, respectively. However, the programme maintains a net benefit both at trial and at scale.
DALY, disability-adjusted life year; HIC, high-income country; SA, South Africa; STI, sexually transmitted infection.