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Cost-Effectiveness Analysis

Cost-effectiveness analysis attempts to determine which practices and policies protect the greatest number of children for the lowest price. In this type of analysis, key measures of program effectiveness (outcomes) are identified, and different strategies to affect those outcomes are compared. Cost-effectiveness analysis might be used by an organization with a limited budget to determine which strategy prevents more cases of child neglect; or, if two strategies achieve similar benefits, it might be used to determine which of these is least expensive to implement.

As with cost-benefit analysis, it is important first to establish a causal relationship between the program and the outcomes claimed, through a valid outcome evaluation.

Outcome measures for child abuse prevention programs may include:

• Reduced incidence of family abuse
• Increased family cohesiveness
• Reduced delinquency
• Reduced child mortality

Programs also need accurate information about the cost of administering the program. Programs can then be compared by dividing program costs by a particular outcome (for example, cost per case of child abuse prevented).

In general, one strategy is considered more cost-effective than another if it is:

• Less costly and at least as effective
• More effective and more costly, but the additional benefit is considered worth the extra cost, or
• Less effective and less costly, when the added benefit is not considered worth the extra cost

Often programs are interested in more than one outcome. In this case, programs can evaluate multiple outcomes separately (e.g., cost per case of child abuse prevented and cost per case of child death prevented) or combine the outcomes into one measure, in a cost-utility analysis. Cost-utility analysis is a variant of cost-effectiveness analysis, where quality of life and life expectancy are combined into a summary measure. For more information about cost-utility analysis, see Cost-Effectiveness Analysis: Methods and Applications (Henry Levin and Patrick McEwan).

Selected Resources Making the Case for Preventing Child Abuse and Neglect: An Overview of Cost Effective Prevention Strategies (PDF - 155 KB) FRIENDS National Resource Center for Community-Based Child Abuse Prevention (2005) Provides a brief review of the costs and benefits of child abuse and neglect prevention and identifies a number of noteworthy prevention programs and strategies. Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches (PDF - 381 KB) Office of the Assistant Secretary for Planning and Evaluation (HHS) (2006) Provides practical advice to help program managers and evaluators understand, design, and perform cost-effectiveness evaluations of community public health prevention programs. Invest in Wisconsin's Children Now (PDF - 163 KB) Wisconsin Children's Trust Fund (2005) Compares Wisconsin's current spending on prevention programs to the total cost to "repair the damage" done by child abuse and neglect. Costs and Effectiveness of Interventions in Child Maltreatment Dubowitz View Abstract Child Abuse & Neglect 14(2), 1990 Addresses issues related to the cost-effectiveness of prevention and intervention in child maltreatment.

Updated on December 7, 2007