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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
family but not readily susceptible to quantification, much less valuation in dollars and cents.
This chapter opens with a brief tutorial on cost-benefit and cost-effectiveness analysis, as well as an explanation of what the terms “cost-beneficial” and “cost-effective” mean. The chapter then synthesizes existing knowledge on the benefits that could be achieved (namely, avoided costs) if prevention were widely implemented on a national scale. Next the available research on the benefits and costs of individual prevention programs or types of intervention is summarized. The chapter then discusses limitations of the available research and concludes by offering recommendations for future research in these areas.
It is important at the outset to acknowledge the basic purpose and limitations of economic analysis in the context of prevention and prevention research. Economic analysis may be valuable at the beginning of prevention research by quantifying the costs associated with the disorder or problem being targeted for prevention, or at least those costs that lend themselves to quantification. This provides a sense of the potential value of prevention of the problem. Evaluating the cost-effectiveness of an intervention at the end of the prevention research cycle helps determine whether funding the intervention is a wise use of societal resources and hence desirable for dissemination. However, economic analysis has limitations as a decision-making aid. In particular, as mentioned above, even the best analyses are challenged to capture all of the psychological and emotional costs associated with MEB disorders in a manner that would be deemed universally acceptable. As a consequence, estimates of the cost of these disorders may misestimate the true social costs, possibly considerably. Equally importantly, economic analysis addresses efficiency but not equity. In some cases, a society or an organization may prefer investing in a less cost-effective program if it is more likely to reach disadvantaged populations. Also, particularly in the context of prevention, economic analysis may rely on a number of unproven assumptions (see Current Knowledge Regarding Intervention Benefit and Costs, below).
The cost-effectiveness of an intervention also often depends on the perspective of the decision maker. In many cases, an intervention is cost-effective from the perspective of society as a whole, but not from the narrower perspective of a single organization considering whether to fund the intervention. For example, consider the case of an investment in prevention of MEB disorders by a health care provider. That provider incurs the costs of the intervention and derives some of the benefits, in the form of reduced future costs of care. However, major social benefits of the intervention may be realized in other sectors of society, including the education sector (e.g., when students are less disruptive in class) and the criminal justice sector (e.g., when recipients of the intervention are less likely to get