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.

Cost-Effectiveness Analysis
U.S. Department of Veterans AffairsExplains what cost-effectiveness analysis is and how it can be used within the context of health care to decide which interventions and services should be used. It highlights recommendations made by a task force of theU.S. Public Health Service, comparisons of interventions, and examples.

Cost-Effectiveness of Family Group Conferencing in Child Welfare: A Controlled Study
Dijkstra, Creemers, van Steensel, Dekovi?, Stams, & Asscher (2018)
BMC Public Health, 18
Examines the short- and long-term cost-effectiveness of family group conferencing (FCG) by comparing outcomes between families participating in FGC and those who did not. The study looked at the costs associated with families’ child welfare involvement.

Home Visiting: The Potential for Cost Savings From Home Visiting Due to Reductions in Child Maltreatment (PDF - 577 KB)
Mathematica Policy Research (2014)
Presents the estimated costs of implementing four program models: Healthy Families America, Nurse Family Partnership, Parents as Teachers, and SafeCare, and describes the additional information needed to assess whether they are cost effective with respect to reductions in child maltreatment and other outcomes.

Nurse-Family Partnership Home Visitation: Costs, Outcomes, and Return on Investment: Executive Summary (PDF - 306 KB)
Miller (2013)
Pew Center on the States & H.B.S.A. Pacific Institute for Research and Evaluation
Analyzes costs, life status outcomes, functional outcomes, and the return on investment rate in Nurse-Family Partnership (NFP) services. Those estimates are also used to create an online calculator and a State-specific financial planning tool to guide NFP funding decisions.

The Power of Prevention for Mothers and Children: The Cost Effectiveness of Maternal and Child Health Interventions
Association of Maternal & Child Health Programs (2018)
Presents evidence of the cost-effectiveness of maternal and child health (MCH) programs, highlights the roles of State Title V MCH programs, and provides examples of which programs were cost-effective.