Preventing Mental, Emotional, and Behavioral Disorders Among Young People Progress and Possibilities (2009) / Chapter Skim
Currently Skimming:
9 Benefits and Costs of Prevention
9 Benefits and Costs of Prevention
Pages 241-262
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From page 241... ...
Emerging evidence that some of these interventions are also cost-effective makes the case even stronger. In an analysis conducted for the committee, Eisenberg and Neighbors estimate that the annual costs of MEB disorders among young people totaled roughly $247 billion in 2007 (see Box 9-1)
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From page 242... ...
Mental disorders: Multiply share of mental health and substance abuse– related DALYs incurred by 0-24 age group (0.355) , times National Institute of Mental Health (2002)
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From page 243... ...
This provides a sense of the potential value of prevention of the problem. Evaluating the cost-effectiveness of an intervention at the end of the prevention research cycle helps determine whether funding the intervention is a wise use of societal resources and hence desirable for dissemination.
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From page 244... ...
Thus, breast or prostate cancer screening and treatment avoid premature deaths, but as they do so primarily for people beyond their working years, many analysts are uncomfortable attributing a dollar value to the beneficiaries' extra years. It is possible to do so, using a measure of willingness-to-pay (Gafni, 1997)
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From page 245... ...
For example, researchers using CBA may ignore improvements in health-related quality of life, because other benefits, such as reduced crime and increased employment, are easier to quantify in dollar terms.
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From page 246... ...
. for considerable costs to the health care, child welfare, education, juvenile justice, and criminal justice systems, as well as enormous additional costs in terms of the suffering of individuals, families, and others affected (see Figure 9-1)
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From page 247... ...
. According to the most recent estimates by age group for the United States, in 1996 mental disorders and substance abuse accounted for 30 percent of DALYs lost by people under age 25 (calculation by Eisenberg and Neighbors based on Supplementary Material, Additional File 4 to Michaud, McKenna, et al., 2006)
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From page 248... ...
. Similarly, as adults, employees with mental When aggregating the costs of mental disorders and substance abuse, it is important to keep in mind that productivity costs may already be reflected, at least to some extent, in measures of health burden, such as DALYs.
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From page 249... ...
considered data from a range of settings and demonstrated that mental health service costs in health care settings represent only a modest fraction of the total costs incurred by children with mental disorders for these services. Using a sample of adolescents ages 13-16 in western North Carolina, they estimated that mental health service costs for adolescents with mental disorders equated to $894 per adolescent in the local population, with more than one-quarter (27 percent)
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From page 250... ...
estimated that each youth with conduct disorder incurs public costs of more than $70,000 over a seven-year period, with costs incurred by the juvenile justice, education, and general health care systems in addition to the mental health system. Similarly, a study in the United Kingdom (Scott, Knapp, et al., 2001)
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From page 251... ...
found that mental health and substance abuse treatment costs for the full population increased from $60 billion in 1991 to $104 billion in 2001. 10 Note also that the estimate of total costs accounted for population growth.
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In addition, further research is needed to improve the ability to project lifetime consequences of mental disorders in childhood. In particular, researchers face the challenge of disentangling confounding factors from true causal relationships in observed relationships between mental disorders in childhood and later outcomes.
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From page 253... ...
Similarly, cost-effectiveness evaluations tend to be limited to such areas as early childhood development, youth development, and prevention of violence, depression, and substance abuse, in which there has been more research overall. In addition, most of the favorable cost-effectiveness results apply to interventions for higher risk populations, although a small number of universal prevention programs have also been shown to be cost-effective.
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From page 254... ...
The benefits from reduced child abuse are generally estimated on the basis of reductions in medical, child welfare, and other public service costs and crime costs, based on epidemiological evidence showing correlations between child abuse and these costs later in life. Improved achievement test scores are usually valued on the basis of how earnings relate to education.
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From page 255... ...
argues that investments in early childhood development, particularly for disadvantaged children, have greater payoff in terms of the development of skills needed for future success than do investments in any other period of life. A systematic review of economic analyses of programs targeting mental health outcomes or accepted risk factors for mental illness by Zeichmeister, Kilian, and colleagues (2008)
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From page 256... ...
. 16 The programs determined to have benefits that exceed costs include the Adolescent Transitions Program, Project Northland, Family Matters, Life Skills Training, Project STAR, the Minnesota Smoking Prevention Program, the Other Social Influence/Skills Building Substance Prevention Program, Project Toward No Tobacco Use, All Stars, and Project Alert.
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From page 257... ...
In addition, as discussed in more detail in Chapter 11, a major challenge in prevention research, particularly when dealing with whole communities, is that preventive interventions are likely to have differential impact on individuals in different contexts because (a) participants have different risk and protective factors that cause different responses to the intervention; (b)
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From page 258... ...
The difficulty in measuring and valuing these costs restricts the potential of CBA and CEA to accurately evaluate the relative merits of preventive interventions for MEB disorders, which may lead to a substantial underestimation of the benefits of successful interventions. Research needs to be devoted to improving measurement methods that will permit assessment of the economic value associated with suffering related to these disorders.
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From page 259... ...
, 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.
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From page 260... ...
17 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)
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From page 261... ...
and mental health should be improved. These links may reveal some of the most important mechanisms by which to prevent MEB disorders in costeffective ways, but it is very difficult to establish incontrovertible causal relationships due to the many likely confounders in observational data.19 While there have been calls for increased economic analyses, the number of projects that include calculation of costs and cost-effectiveness will increase only if guidelines on how to conduct these types of analyses are widely available and the additional costs recognized.
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From page 262... ...
In concluding this discussion, it is important to note that the significant societal benefits of preventing mental, emotional, and behavioral problems among young people may warrant intervention even when there is no specific cost-effectiveness data available, particularly if there is evidence that an effective intervention is available. Waiting for future cost-effectiveness analyses to become available, which might take years to develop, would put many young people at unnecessary risk.
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