Can a costly intervention be cost-effective?: An analysis of violence prevention

Arch Gen Psychiatry. 2006 Nov;63(11):1284-91. doi: 10.1001/archpsyc.63.11.1284.


Objectives: To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact.

Design: Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study.

Results: Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria.

Conclusions: Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Budgets / statistics & numerical data
  • Child
  • Child Behavior Disorders / economics
  • Child Behavior Disorders / prevention & control
  • Conduct Disorder / economics
  • Conduct Disorder / prevention & control*
  • Conduct Disorder / psychology
  • Cost-Benefit Analysis
  • Crime / economics
  • Crime / prevention & control
  • Female
  • Health Policy / economics
  • Humans
  • Juvenile Delinquency / economics
  • Juvenile Delinquency / prevention & control*
  • Juvenile Delinquency / psychology
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data
  • Preventive Health Services / economics*
  • Preventive Health Services / methods
  • Primary Prevention / economics
  • Primary Prevention / methods
  • Program Evaluation / economics*
  • Risk Factors
  • Violence / prevention & control*
  • Violence / psychology