underestimating total costs. For example, some studies do not consider the opportunity cost incurred by teachers delivering an intervention who might otherwise be engaged in productive teaching activities (Aos, Lieb, et al., 2004). Finally, and importantly, other intangibles, most notably the suffering of children and their families, are likely to be costly but extremely difficult to quantify and assign a monetary value. The difficulty in measuring and valuing these costs restricts the potential of CBA and CEA to accurately evaluate the relative merits of preventive interventions for MEB disorders, which may lead to a substantial underestimation of the benefits of successful interventions. Research needs to be devoted to improving measurement methods that will permit assessment of the economic value associated with suffering related to these disorders.

Another important caveat is that the quality of the underlying evidence used to project costs and benefits varies. Aos, Lieb, and colleagues (2004) account for this in their meta-analysis by assigning different weights to studies based on indicators of quality, but such a solution has unavoidable limitations, as the authors acknowledge. Many evaluations do not meet some of the important guidelines for quality of evidence, as stated by such organizations as the Food and Drug Administration (1998) and the Society for Prevention Research (Flay, Biglan, et al., 2005). For example, evaluators have not always published a specific plan of analysis before collecting data, which leaves open the possibility of selectively reporting positive results among many outcomes and analytical approaches.

A final caveat for this literature is the reminder that, while some studies employ CEA, most of the studies in the prevention field have employed CBA. In practice, CEA and CBA results are not strictly comparable. However, in this literature, because most of the studies yield strong conclusions (positive in most cases), it is unlikely that the basic findings would be sensitive to the choice of method. As this literature evolves and more interventions with borderline cost-effectiveness are evaluated, examining the sensitivity of conclusions to alternative assumptions will be important.


The potential value of prevention of MEB disorders among young people is enormous. MEB disorders among young people result in significant costs to multiple service sectors. Such disorders threaten children’s future productivity and wellness and disrupt the lives of those around them.

Conclusion: The economic, social, and personal costs of MEB disorders among young people are extraordinarily high.

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