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An Analysis of Violence Prevention

E. Michael Foster, PhD; Damon Jones, PhD; and the Conduct Problems Prevention Research Group^*

Arch Gen Psychiatry. 2006;63:1284-1291.

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.

Author Affiliations: School of Public Health, University of North Carolina, Chapel Hill (Dr Foster); and Penn State University, University Park (Dr Jones).
*Authors/Writing Committee: Members of the Conduct Problems Prevention Research Group, in alphabetical order, include Karen L. Bierman, PhD; John D. Coie, PhD; Kenneth A. Dodge, PhD; E. Michael Foster, PhD; Mark T. Greenberg, PhD; John E. Lochman, PhD; Robert J. McMahon, PhD; and Ellen E. Pinderhughes, PhD.