Table 4

Framework for estimating the benefits associated with averting a case of childhood physical or emotional abuse, from a societal perspective

Category of benefitRationaleData sourceSaving per case of abuse averted* (US$)
Direct saving
Health service useCosts associated with immediate injuriesAmount attributable to abuse unknown for SA
Social service useCosts associated with investigation and immediate response to an abuse caseSocial worker time approximated from current wages and norms set by Barberton’s costing of SA social care bill, assumes all cases are investigated appropriately39553†
Child care and court costsCosts associated with processing and supporting a child in foster care, the outcome of most severe abuse cases in SATotal child welfare bill was ZAR 1.58 billion in 2015, but proportion attributable to physical or emotional abuse unknown
Indirect saving
DALYs avertedLifetime costs associated with attributable increased risk of mental health problems, substance abuse and STIsFang 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 al1116821929
Long-term health service useCosts associated with use of health service associated with mental health problems, substance abuse and STIsAmount attributable to abuse unknown for SA
Productivity lossEstimated value of individual productivity loss for a victim of abuse due to long-term health impactsFang et al,12 approximated to case level using prevalence from Burton et al11408322
Delinquency/criminal systemVictims of childhood abuse are more likely to become criminals incurring costs to the criminal systemUnknown for SA, but form a considerable proportion of the savings attributable to parenting programmes in HICs26
Intergenerational costsVictims 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 averted26442804
  • *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.