Online ISSN: 1099-176X Print
Copyright © 2007 ICMPE.
The Economic Analysis of Prevention: An Illustration Involving Children's Behavior Problems
E. Michael Foster,1* Damon E. Jones2
1Ph.D., Professor of Maternal and Child Health; of Health Policy and
Administration; and of Biostatistics (adjunct), School of Public Health, University of North Carolina-Chapel Hill, ChapelIll, NC, USA
Correspondence to: E. Michael Foster, School of Public
Health, University of North Carolina,
Chapel Hill, Rosenau Hall,
Campus Box #7445, Chapel Hill, NC27599-7445, USA.
Tel.: +1-919-966 3773
Fax: +1-919-966 0458
Source of Funding: The members of the Conduct Problems Prevention Research Group (CPPRG) designed the original study and intervention. This work was supported by National Institute of Mental Health (NIMH) grants R18 MH48043, R18 MH50951, R18 MH50952, and R18 MH50953. The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also have provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part by Department of Education grant S184U30002 and NIMH grants K05MH00797 and K05MH01027. The economic analysis of the Fast Track project is supported through R01MH62988.
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.
Received 6 February 2007; accepted 16 November 2007
Copyright © 2007 ICMPE