Preventions Cost Effectiveness Illustrative Economic Benefits of General Population Interventions

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Preventions Cost Effectiveness? Illustrative
Economic Benefits of General Population
Interventions

• Richard Spoth and Max Guyll
• Partnerships in Prevention Science Institute
• and Department of Psychology
• Iowa State University
• United Nations Office on Drugs and Crime
• Technical Seminar on Drug Addiction Prevention
  and Treatment From Research to Practice
• December 16, 2008

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Potential Economic Benefits of Prevention

• Preventive interventions most likely to be
  economically beneficial when...
• Prevented condition is prevalent
• Condition is costly
• Effective preventive interventions are available
• Interventions costs are low

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Prevention Spending is an Investment

• Prevention costs spent in the present for
  benefits returned in future
• Intervention costs and effects are known
• Benefits must be estimated across the future,
  discounted to determine value in present

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Return on Investment(Benefit-cost ratios) of
Selected Programs

• Pre-school education
• Early Childhood Education.........................
  ................2.36
• Child welfare
• Nurse Family Partnership..........................
  .................2.88
• Youth development
• Guiding Good Choices (PDFY).......................
  ........11.07
• Juvenile offender programs
• Dialectical behavior therapy......................
  ..............38.05

Source Aos, Lieb, Mayfield, Miller Pennucci
(2004)
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Economic Benefits ofSubstance-Use Prevention in
General

• Prevention benefits
• Increased productivity, tax revenues
• Lower health care costs
• Reduced justice system costs
• Decreased welfare, victim, fire costs
• Potential benefits are greatest where current
  costs of prevented condition are greatest

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Rationale for IllustrativeEconomic Analyses of
SubstancePrevention (Alcohol/Meth)

• Prevention with general populations could save
  billions
• In U.S., annual alcohol costs estimated at 228.5
  billion for adults, 89.5 billion for youth
• Annual drug costs estimated at 151.3 billion
• Employee methamphetamine use cost to employers
  estimated at 31.8 billion per year
• Economic analyses assist in estimating value of
  interventions and identifying interventions that
  hold most promise

Using most recent estimates and adjusting for
inflation to current year.
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Case Study of Billy or Betty Costs of Life
Trajectory of Early Substance Use and Problem
Behaviors
Resident home expenses 50,000 Medicaid
110,000 Special
education 28,000 State hospital
128,000 Legal (estimated)
20,000 Total
336,000
Increasing Costs
Level of Problem Behaviors
Trajectory of Problems/
Early Childhood
Young Adulthood
Illustrative case history and cost projections
from Dennis Embry (PAXIS Institute).
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Future Annual Benefits from Preventing a Single
Alcohol Use Disorder
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Cost-effectiveness (CE) vs. Cost-benefit (CB)

• CE yields cost to achieve a particular
  outcomesuch as prevention of an alcohol-use
  disorder
• Cost to produce a unit of prevention
• CE

Prevention Cost Prevention Effect
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Cost-effectiveness (CE) vs. Cost-benefit (CB)

• CB assesses whether savings generated by
  prevention are greater than costs spent on
  prevention
• Important when monetary resources are limited
• Assists policy/decision-makers in choice of which
  intervention to fund
• CB

Benefit of Prevention Effect (Cost Savings) Cost
per each Prevention Effect
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Empirical Examples

• Longitudinal randomized intervention-control
  prevention trials
• Project Family Randomized Controlled Trial
• 667 families recruited through 33 Iowa school
  districts
• Example Iowa Strengthening Families Program
  (ISFP) for general populations (universal
  intervention)
• Capable Families and Youth Trial
• 679 families recruited through 36 rural Iowa
  school districts
• Example Life Skills Training Program (LST) for
  general populations (school-based)

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Estimates of Costs

• Illustrative cost categories (for family program)
• Program facilitation (38)
• Facilitator training (30)
• Incentives and child care (21)
• Site administration (6)
• Materials (3)
• Total ISFP cost 68,856 per 100 families
• Total LST cost 15,500 per 100 students

Sources Spoth, R., Guyll, M., Day, S. X.
(2002). Universal family-focused interventions in
alcohol-use disorder prevention
Cost-effectiveness and cost-benefit analyses of
two interventions. Journal of Studies on
Alcohol, 63(2), 219-228 Guyll, Spoth, Madon
(2008). Economic analysis of prevention effects
on methamphetamine use An employers
perspective. Unpublished manuscript.
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Cost-effectiveness-Final Calculations

• Prevention cost
• Prevention effect
• For alcohol (ISFP case)
• Cost of 68,856 per 100
• 5.5 cases prevented per 100
• 12,459 cost per disorder
  prevented
• Meth use (LST) 15,500/3.2 cases 4,921 per
  meth use case prevented
• Difference between control and intervention
  group cases

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Savings for Each Unit of Prevention

• ISFP Case
• Benefit per alcohol disorder prevented
• 244,288 (Before discounting)
• 119,633 (After discounting)
• LST Case
• Employer benefit per meth user prevented
• 402,961 (Before discounting)
• 130,013 (After discounting)

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Benefit-Cost Ratios Across Two Studies
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Conclusions

• Evidence that prevention more than pays for
  itself (e.g., 10 returns/dollar invested)
• Illustrative analyses were relatively
  conservative
• Conservative estimates of interventions level of
  efficacy (e.g., intent-to-treat)
• Considered only costs avoided by prevention of
  one type of outcome in fact multiple cost-saving
  outcomes produced
• Did not include estimate of societal willingness
  to pay to prevent each alcohol-use disorder
• Effective and efficient prevention promises to
  save, possibly, billions of dollars per year,
  provided we can learn how to effectively
  implement on a larger scale...

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• Acknowledgement of
• Our Partners in Research
• Investigators/Collaborators
• R. Spoth (Director), C. Redmond C. Shin
  (Associate Directors),
• T. Backer, K. Bierman, G. Botvin, G. Brody, S.
  Clair,
• T. Dishion, M. Greenberg, D. Hawkins,
• K. Kavanagh, K. Kumpfer, C. Mincemoyer,
• V. Molgaard, V. Murry, D. Perkins, J. A. Stout
• Associated Faculty/Scientists
• K. Azevedo, J. Epstein, M. Feinberg, K. Griffin,
• M. Guyll, K. Haggerty, S. Huck, R. Kosterman,
• C. Lillehoj, S. Madon, A. Mason, J. Melby, M.
  Michaels,
• T. Nichols, K. Randall, L. Schainker,
• T. Tsushima, L. Trudeau, J. Welsh, S. Yoo
• Prevention Coordinators
• E. Berrena, M. Bode, B. Bumbarger, E. Hanlon
• K. James, J. Meek, A. Santiago, C. Orrson

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