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.