2008; Zeichmeister, Kilian, et al., 2008).17 Many preventive interventions have been shown to be highly effective but have not yet been evaluated for cost-effectiveness in real-world settings. Guidelines on how to conduct high-quality cost-effectiveness studies are needed to help shape the development of this area of research as it continues to evolve.

Recommendation 9-1: The National Institutes of Health, in consultation with government agencies, private-sector organizations, and key researchers should develop outcome measures and guidelines for economic analyses of prevention and promotion interventions. The guidelines should be widely disseminated to relevant government agencies and foundations and to prevention researchers.

For interventions involving young people, long-term outcomes are often pivotal for determining cost-effectiveness, as significant benefits are likely to accrue into adulthood, yet current knowledge is remarkably weak in most contexts. Long-term follow-up data should be collected whenever possible. As electronic data systems become more integrated and accessible, one promising avenue is through administrative databases, which do not necessarily depend on expensive efforts to track down and interview participants.18 CEAs should also make clear the various sources of uncertainty. If the cost-effectiveness results are dramatically positive or negative, wide intervals may not raise questions about the overall conclusion that an intervention is cost-effective, but publishing such information will make the assessment more transparent. Special attention should be given to addressing the fact that costs from an intervention in one sector may be evident in other sectors. While this has been done for early childhood, less attention has been focused on this issue in other developmental stages, such as adolescence.

Economic analyses should also be comprehensive in their accounting of relevant costs and benefits. The work by Costello, Copeland, and colleagues (2007), for example, illustrates the importance of measuring costs across a range of service venues. Again, integration of electronic data systems may be a valuable tool for capturing these costs. To capture the benefit of reductions in specific MEB disorders, interventions should measure diagnostic outcomes whenever possible.


This is an issue not only for prevention but also for treatment of mental disorders in children. A comprehensive review of economic evaluations of child and adolescent mental health interventions (most of which are treatment, not prevention) found only 14 had been published to date, although the authors speculated that two or three times that many would be in print within five years (Romeo, Byford, and Knapp, 2005).


Of course, researchers would need to overcome hurdles related to informed consent and privacy restrictions.

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