The economic analysis of prevention: an illustration involving children's behavior problems.

BACKGROUND

Economic analyses of programs to prevent or treat behavioral health problems among children and youth are an important component of intervention research.

AIMS OF THE STUDY

This study examines the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence in at-risk children. Analytic models estimate intervention cost-effectiveness allowing for sampling variation and considering alternative policy-maker willingness to pay levels.

METHODS

Costs of the intervention were estimated using program budgets. The probability of intervention effectiveness is mapped against willingness to pay using cost-effectiveness acceptability curves (CEAC). Cost-effectiveness is gauged using three outcomes measured in grade 9: diagnosis of conduct disorder; acts of interpersonal violence avoided; index criminal offense avoided.

RESULTS

Evaluation of the total sample shows that the intervention was not cost-effective at anticipated levels of policy maker's willingness to pay. For those most at-risk, however, the intervention was likely cost-effective.

DISCUSSION

Outcome measures are based on parent reports and so may be subject to respondent bias. Future costs related to conditions such as conduct disorder are speculative based on previous research.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE

Researchers must consider the population targeted for delivery of intervention services when evaluating cost-effectiveness of their intervention. This study indicates that the intervention was cost-effective only for youth most at-risk for behavioral problems. This result implies that overall cost-effectiveness would be improved by better targeting.

IMPLICATIONS FOR HEALTH POLICIES

The intervention is cost-effective for the highest risk children. From a policy standpoint, this finding is encouraging since such children are likely to generate high costs for taxpayers and society over their lifetimes. Nonetheless, the initial outlay required to finance the program is substantial.

IMPLICATIONS FOR FURTHER RESEARCH

Interventionists should consider program costs in designing interventions in order to better balance feasibility with efficacy.