Although the potential benefits from preventing MEB disorders are clearly large, and there is a substantial and growing body of evidence documenting the positive outcomes of prevention interventions, relatively few evaluations have been conducted to assess the cost-effectiveness of the interventions. The evaluations that are available tend to be those associated with the interventions with the longest follow-up and include some of the most successful programs. Similarly, cost-effectiveness evaluations tend to be limited to such areas as early childhood development, youth development, and prevention of violence, depression, and substance abuse, in which there has been more research overall. In addition, most of the favorable cost-effectiveness results apply to interventions for higher risk populations, although a small number of universal prevention programs have also been shown to be cost-effective.

Aos, Lieb, and colleagues (2004) reviewed the economic analyses of a large number of relevant interventions. The authors conducted a comprehensive and detailed review and analysis for the Washington State government of prevention and early intervention programs designed to (1) reduce crime; (2) lower substance abuse; (3) improve educational outcomes, such as test scores and graduation rates; (4) decrease teen pregnancy; (5) reduce teen suicide attempts; (6) lower child abuse or neglect; and (7) reduce domestic violence. In addition to the discussion below based in part on their analysis, we refer the reader to this study as a resource for additional empirical results as well as a detailed discussion of methodological issues.

Early Childhood Interventions

Perhaps the most heavily researched preventive programs are early childhood interventions for children from birth to age 5. Some of these programs are primarily home-based, whereas others are primarily center-based. In a meta-analysis of over 25 studies of home visitation programs (by nurses or other trained professionals), Aos, Lieb, and colleagues (2004) concluded that the average benefits per child were about $11,000 and costs were about $5,000.12 The benefit-cost ratio has been shown to be higher for certain programs; for example, in an economic evaluation of the Nurse-Family Partnership Program, Karoly, Kilburn, and Cannon


 All dollar values in this section are in 2002 or 2003 dollars. In addition to average effects for this group of programs, Aos, Lieb, and colleagues also estimated the benefits of the Nurse-Family Partnership at $26,298 and the costs at $9,118 and the benefits of the HIPPY (Home Instruction Program for Preschool Youngsters) at $3,313 and the costs at $1,837. They estimated that benefits exceeded costs for the Comprehensive Child Development Program and the Infant Health and Development Program.

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