Cost-benefit analysis of universal pool fencing for Texas households with young children

Abstract

Abstract Background Texas bears a disproportionate burden of pediatric drowning in the United States. Functional pool fencing prevents pediatric drownings, but its economic impact on drowning-related costs remains unclear. We estimated the potential cost savings of implementing a universal pool fencing program for households with young children. Methods We conducted a cost-benefit analysis of universal pool fencing for Texas households with one or more children ages 1–9 years. Drowning burden was estimated from Texas data with a case-fatality rate of 1:6. Direct medical and lifetime indirect costs per patient and caregiver were derived from hospital discharge data and literature. Prevented drownings were estimated using a population-wide risk model incorporating fence effectiveness and current fence coverage (percent of homes with functional fences). Average pool fence cost was obtained from industry experts, assuming a 10-year lifespan and no maintenance costs. Population and household estimates were derived from U.S. Census data to determine the number of fences required. Total program costs were calculated by multiplying the number of fences required by the average cost per fence. Annual cost savings were calculated from prevented cases and per-case costs. Benefits over a 10-year period were estimated as the present value of annual savings discounted at 5%. Net benefit was defined as 10-year benefits minus total fencing program costs. Results The annual fatal and non-fatal drowning burden in Texas among children ages 1–9 years is 264 cases. With 76% fence effectiveness and 38% current fence coverage, an estimated 174 drownings could be prevented annually. The average cost per drowning is $337,435 (direct medical: $60,860; lifetime indirect: $276,575). With 7% of Texas households having a pool, an estimated 98,905 new fences are required at a cost of $3,343 each, totaling $330,642,758 in program costs. Annual cost savings are $58,713,690, corresponding to $453,371,551 in 10-year benefits and a net benefit of $122,728,793. Conclusions Universal pool fencing in Texas could prevent pediatric drownings and yield significant economic savings. These findings support stronger residential pool safety standards, including statewide mandates, robust inspection and enforcement tied to permitting, and financial incentives such as rebates or insurance discounts to offset installation costs.