OBJECTIVES Child development is strongly influenced by early life experiences, and negative or traumatic experiences can have long lasting consequences. Home visiting interventions have been widely employed to improve outcomes for families, children and young people at risk or experiencing disadvantage. As policy-makers must allocate scarce resources carefully by deciding which programs are implemented, to whom, and at what time, appropriate methodology is required. We aimed to investigate methodologies used for economic analysis of home visiting programs, with an emphasis on methodologies for trials where randomisation was not feasible, as this is a common issue in social care. We also investigated costs and effects related to implementation of programs in real-world settings, and what types of cost data were collected in the included studies.

METHODS We conducted a systematic review of economic analysis methods used in home visiting programs for children, young people and families. Included studies were published in English between January 2000 and September 2019.

RESULTS Fifty-two of the 3,809 papers sourced were retained for full-text review, and 18 were included. Methodologies were cost-comparison, cost-consequence, within-trial cost-effectiveness, cost-utility and cost-benefit analysis. Additional components were return-on-investment and budget-impact analyses. Where individual randomisation was not feasible, research methodologies included parallel cluster-randomised-trials by geographical area and utilisation of pre-post intervention outcome data. Only one study reported implementation costs/effects. The main predictors of costs were study specific, but tended to be for clinician salaries.

CONCLUSION Flexible tools are required to evaluate interventions in the social care sector. As interest in implementation science increases, it is important that health economists are equipped to study the costs and effects of implementation studies. We hope that this paper will help guide future economic evaluations in order to inform policy-makers of the costs and benefits of implementing home visiting interventions.