Can a costly intervention be cost-effective?: An analysis of violence prevention.
OBJECTIVE
To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact.


METHODS
Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study.


RESULTS
Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria.


CONCLUSIONS
Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations.
Foster
E Michael
EM
School of Public Health, University of North Carolina, Chapel Hill 27599-7445, USA. emfoster@unc.edu
Jones
Damon
D
D000293:Adolescent; D002017:Budgets / Q000706:statistics & numerical data; D002648:Child; D002653:Child Behavior Disorders / Q000191:economics / Q000517:prevention & control; D019955:Conduct Disorder / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D003362:Cost-Benefit Analysis; D003415:Crime / Q000191:economics / Q000517:prevention & control; D005260:Female; D006291:Health Policy / Q000191:economics; D006801:Humans; D007604:Juvenile Delinquency / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000191:economics* / Q000379:methods; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D015397:Program Evaluation / Q000191:economics*; D012307:Risk Factors; D014754:Violence / Q000517:prevention & control* / Q000523:psychology