A Return-On-Investment Analysis for Lead Poisoning Case Management in New York City.

OBJECTIVES

To evaluate the return on investment (ROI) and social return on investment (SROI) of childhood lead poisoning case management in New York City by quantifying direct cost savings and long-term societal benefits associated with intervention among children with elevated blood lead levels.

DESIGN

Mixed-methods economic modeling study estimating ROI and SROI using program cost data, published outcome valuations, and sensitivity analyses for 1462 high-risk NYC children.

SETTING

New York City Department of Health-led lead poisoning case management program serving high-risk children in urban housing.

PARTICIPANTS

One thousand four hundred sixty two New York City children with blood lead levels ≥10 μg/dL who received case management and environmental inspections.

INTERVENTION: Public health nurse-led case management, including home inspections, lead hazard remediation coordination, medical monitoring, and family support services.

MAIN OUTCOME MEASURE: ROI and SROI, including avoided medical, education, productivity, justice, and quality-of-life costs.

RESULTS

Baseline ROI was 1.34 ($2.34 saved per $1 invested); SROI was 26.37, reflecting more than $98 million in lifetime societal benefits for the full cohort of 1462 children.

CONCLUSIONS

Lead poisoning case management generates substantial economic and societal returns, supporting sustained investment as a high-impact, equity-focused public health strategy.