Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, 80523, USA.
School of Social Work, Colorado State University, Fort Collins, CO, USA.
Prev Sci. 2019 May;20(4):566-574. doi: 10.1007/s11121-018-0958-6.
Evidence-based prevention interventions hold great promise for enhancing the well-being of individuals, families, and society. As these interventions are implemented in new contexts and at wider scales, policymakers and private sector organizations are increasingly interested in understanding the economic returns that programs produce through reductions of burden on public service systems, such as criminal justice and human services. Thus, it is important to ensure that economic models account for factors, such as retention, which are important when interventions are implemented in real-world contexts with selective populations and voluntary participation. Yet the field of prevention has provided little guidance to help researchers and policymakers analyze the economics of interventions so that estimates reflect the impact of implementation factors on intervention cost-effectiveness. This paper discusses the role retention plays in the economic efficiency of interventions when the prevention of child maltreatment is the primary motivation for funding these programs. We present a conceptual model to serve as a guide for explicit inclusion of retention rates when calculating cost estimates to be used in cost-effectiveness analysis. A case study is presented, demonstrating the variability in estimates dependent on the definition of retention and the estimated retention rate. The results underscore the importance of improving our understanding of factors underlying and related to retention, such as engagement, which may improve the precision of cost and cost-effectiveness analysis in applied settings.
循证预防干预措施为增进个人、家庭和社会的福祉带来了巨大的希望。随着这些干预措施在新的背景下和更大的范围内实施，政策制定者和私营部门组织越来越有兴趣了解这些项目通过减少公共服务系统（如刑事司法和社会服务）的负担而产生的经济效益。因此，重要的是要确保经济模型考虑到一些因素，如保留率，当干预措施在具有选择性人群和自愿参与的现实环境中实施时，这些因素非常重要。然而，预防领域几乎没有提供什么指导，以帮助研究人员和政策制定者分析干预措施的经济学，以便估计反映实施因素对干预成本效益的影响。本文讨论了在儿童虐待预防是资助这些项目的主要动机的情况下，保留率在干预措施的经济效率中的作用。我们提出了一个概念模型，作为在计算成本效益分析中使用的成本估算时明确纳入保留率的指南。展示了一个案例研究，说明了估计值的变化取决于保留的定义和估计的保留率。结果强调了提高我们对保留率相关因素的理解的重要性，例如参与度，这可能会提高应用环境中成本和成本效益分析的准确性。
