Presenter Profile
James "Trey" Rhodes, MD
Baylor College of Medicine | Texas Children’s Hospital
james.rhodesiii@bcm.edu
Dr. Trey Rhodes is a Pediatric Resident Physician at Texas Children’s Hospital through Baylor College of Medicine, where he served as a leader of the residency’s Advocacy Committee. He is passionate about child injury prevention and is a member of the Trainees for Child Injury Prevention (T4CIP) program, leading local, evidence-based education initiatives for families and physicians. His current research evaluates the economic benefits of four-sided isolation pool fencing to prevent pediatric drowning in Texas. Dr. Rhodes was selected for the American Academy of Pediatrics (AAP) Advocacy Internship and will spend a month on Capitol Hill this spring advancing child injury prevention policy. He will begin fellowship training in Pediatric Critical Care Medicine this upcoming summer and aims to integrate his clinical work in the ICU with policy-driven advocacy to safeguard children before they ever need intensive care.
Presentations
Cost Savings Analysis of Universal Swimming Pool Fencing in Texas
James "Trey" Rhodes, MD
Linh Nguyen, PhD
Rohit P. Shenoi, MD
Texas ranks among the highest in pediatric drowning fatalities in the United States. Functional pool fencing reduces drowning risk in children, yet its economic benefit in preventing pediatric drowning is unknown.
We estimated the cost savings from instituting a universal fencing program in Texas among children 1-9 years old. The mean annual number of drowning fatalities in children aged 1-9 in Texas was obtained through CDC Wonder. The number of nonfatal drownings were estimated based on a drowning case-fatality rate of 1:6. Drowning burden included fatal and nonfatal drownings. The total cost of drowning was estimated using the Texas Health Care Information Collection data (2016-2022), including medical costs and indirect costs incurred by a pediatric patient and caregiver due to drowning. The average cost for a medium-sized swimming pool fence was obtained from pool companies. We assumed zero fence maintenance costs for a 10-year period since this is the average fence lifespan and time for an infant to grow into an older child not needing supervision.
Based on the literature, we estimated a fence to be 76% effective in preventing drowning. Using information on pediatric drownings in Harris County, Texas, we assumed current functional pool fencing coverage to be 38%. We also assumed each drowning case corresponds to one home, and risk reduction applies uniformly.
The number of prevented drownings was calculated by multiplying the annual number of drownings by the effectiveness rate of pool fencing and (1-coverage rate). Total cost savings were estimated by multiplying the number of prevented drownings due to pool fencing by the average cost per case. The net benefit of instituting pool fencing was estimated by subtracting the cost savings from the cost of universal pool fence installation. Cost savings per case prevented were calculated as the cost savings divided by prevented cases.
From 2018-2023, there were 264 (44/year) fatal swimming pool drownings in Texas among children 1-9 years old. Using a pediatric drowning case-fatality rate of 1:6, the annual burden of fatal and nonfatal drowning in Texas children aged 1-9 is 264 cases.
Based on the 76% effectiveness of pool fencing in preventing drowning and 38% of homes with functional fences, the annual number of prevented drownings is 124 cases. The total costs incurred by a patient and caregiver per pediatric drowning patient in Texas are $337,435 (medical costs: $60,860; lifetime indirect costs: $276,575). The annual cost savings from 124 prevented cases by instituting universal pool fencing in Texas is $41,841,940. With the average cost for a medium-sized swimming pool fence of $3,343, the total cost of installing a functional fence for the remaining 62% of homes is $548,252.
The annual net benefit of instituting universal pool fencing is $41,293,688. The cost savings per case prevented is $333,014.
Drowning-associated lifetime costs are enormous in Texas. Instituting a statewide universal pool fencing program will result in significant long-term savings.
1. Discuss the characteristics of functional swimming pool fencing.
2. Identify barriers to instituting functional swimming pool fencing in Texas.
3. Compute the economic benefit of a universal swimming pool fencing program in Texas.