To date, there is some evidence that the benefits of some specific interventions outweigh the costs. However, the scientific literature on the cost-effectiveness of prevention is still young, and it faces a number of conceptual and practical obstacles.

Conclusion: The current body of research on costs, cost-effectiveness, and cost-benefits of preventive mental, emotional, and behavioral interventions is very limited.

Much of the strongest evidence to date is for interventions that improve protective factors or reduce risk factors demonstrated through research to be closely related to MEB disorders (see Chapter 4). For example, multiple economic evaluations of early childhood development programs have demonstrated benefits that exceed costs.

It is also notable that among the limited number of interventions shown to be cost-effective, many were either targeted to higher risk children (e.g., the early childhood programs such as the Perry Preschool project) or were cost-effective only for a higher risk subgroup within the analysis (e.g., the Fast Track study). Aside from a small number of substance use prevention programs (see review by Aos, Lieb, et al., 2004), few universal interventions have been demonstrated to be cost-effective for preventing MEB disorders. Future research is needed to determine whether selective and indicated prevention programs are inherently more likely to be cost-effective in the context of MEB disorders, or if this finding is an artifact of the programs that happen to have been subjected to economic evaluations thus far.

Conclusion: Of those few intervention evaluations that have included some economic analysis, most have presented cost-benefit findings and demonstrate that intervention benefits exceed costs, often by substantial amounts.

However, few studies measure effects on diagnosable MEB disorders as an outcome, and most do not conduct sufficient longitudinal follow-up to fully capture potential long-term benefits. Also, considerable uncertainty remains about some of these estimates. Economic analyses are important for quantifying the potential value of prevention and assessing the actual value of existing interventions.

Many scholars in the prevention field have called for more regular economic analyses (Flay, Biglan, et al., 2005; Spoth, Greenberg, and Turrisi,



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