Can a costly intervention be cost-effective?: An analysis of violence prevention

Abstract

Objectives: 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.

Design: 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.

Figure

Incremental cost-effectiveness ratios (ICERs) for Fast Track sample and subsamples (lower- and high-risk): incremental cost per case of conduct disorder (CD) averted. Each point represents the costs and effects of intervention/treatment (Tx) on the cost-effectiveness plane. The slope of the corresponding line is the incremental cost-effectiveness ratio. Effectiveness measure scaled such that the x-axis is the increase in nondisordered cases. Abbreviation: WTP, willingness to pay.