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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
Interventions Targeted at Specific Mental, Emotional,and Behavioral Disorders or Substance Use
There are currently few economic analyses of interventions that target the prevention of specific MEB disorders or substance use among young people, although there are a large number of studies that document efficacy, effectiveness, or both (see Chapters 6 and 7). The interventions in these economic analyses address depression, violence and conduct disorder, and substance use. Lynch, Hornbrook, and colleagues (2005) performed a cost-effectiveness analysis of a highly successful group cognitive-behavioral therapy intervention to prevent depression among adolescent children of depressed parents (see Box 7-4). They found that the intervention is very likely to be cost-effective, with an incremental cost of $610 per child and a cost-effectiveness ratio of $9,275 per QALY15 (95 percent CI, –$12,148 to $45,641). Foster, Jones, and Conduct Problems Research Group (2006) found that the Fast Track intervention, designed to reduce violence and conduct disorders among at-risk children, was about 70 percent likely to be cost-effective in preventing conduct disorder for the higher risk group, but it had less than a 0.01 probability of being cost-effective for the lower risk group, which represented the majority of the sample. Aos, Lieb, and colleagues (2004) found that 10 of the 12 substance use prevention programs (including two programs that focus on smoking prevention) they analyzed were highly cost-effective, with benefit–cost ratios ranging from 3 to over 100.16 The estimated benefits per child were generally small (less than $1,000 in most cases), but the costs were even smaller (less than $200 in all but one program).
Current Knowledge Regarding Intervention Benefits and Costs
Overall, knowledge about the benefits and costs of specific interventions aimed at preventing MEB disorders is promising but still limited. Relative to the number of efficacious or effective interventions (see Chapters 6 and 7), few investigators have conducted cost-effectiveness or cost-benefit analyses. There is also considerable uncertainty about many of the estimates in the available literature. For interventions that exhibit dramatically dif-
QALYs, like DALYs, are measures of health that account for both morbidity and mortality. As mentioned earlier, ratios under $50,000 per life year lost are generally considered cost-effective; this is regardless of whether life years are adjusted for quality of life (Ubel, Hirth, et al., 2003).
The programs determined to have benefits that exceed costs include the Adolescent Transitions Program, Project Northland, Family Matters, Life Skills Training, Project STAR, the Minnesota Smoking Prevention Program, the Other Social Influence/Skills Building Substance Prevention Program, Project Toward No Tobacco Use, All Stars, and Project Alert. DARE and STARS for Families were ineffective, making the costs exceed the benefits by definition.