Cost–benefit analysis of a media campaign to increase registrations of Power of Attorney in Scotland

Abstract

BackgroundThe number of days patients are delayed in hospital because a welfare Power of Attorney (POA) has not been registered is increasing. This problem is costly and blocks beds. The aim of this study was to measure the cost–benefit ratio of a media campaign to increase POA registrations. MethodsThe media campaign (television, radio, YouTube, and billboard advertising) began in Glasgow in November, 2013, with seven other local authorities subsequently joining. Mean length of stay for adults with incapacity delayed in hospital was calculated from routinely collected delayed discharge data. Published data on hospital admissions and adults with incapacity were used to calculate the probability of a person being admitted to hospital and subsequently becoming an adult with incapacity delayed there. Using this information and previously published estimates of registrations generated per phase of campaign, under an interrupted time-series analysis, estimated bed day costs avoided were compared with the cost of the campaign. A sensitivity analysis was carried out, using different probability assumptions for new registrants' survival and becoming an incapacitated hospital patient. FindingsThe campaign cost was met by cost savings of two new registrants avoiding becoming a delayed adult with incapacity at any future time. 1486 (95% CI 1281–1746) of the 11 366 POA registrations across Scotland during the first quarter of 2015 were due to the media campaign. The campaign cost £60 385 per phase, with estimated savings of £191 743 (95% CI 165 292–225 292) in prevented delayed bed days, giving a net benefit of £131 358 (104 907–164 907) per campaign phase and a benefit–cost ratio of 3·17 (under the assumption that all new registrants lived for 5 years and that their probability of becoming a delayed adult with incapacity remained the same during this time). A sensitivity analysis found a benefit–cost ratio range of 2·73—10·16, adjusting for these assumptions. This analysis excludes known spill-over effects such as other family members subsequently registering a POA, and non-monetary benefits including the avoided emotional cost to family members of the guardianship process. InterpretationThis analysis shows that the media campaign was cost effective even under fairly conservative assumptions. FundingGlasgow City Council (GCC) provided financial support for the preparation of the article. GCC had no role in the analysing of data, interpretation, writing of the abstract, or the decision to submit it for publication.