Evidence-Based Treatment Programs for Conduct Problems: Are They Cost Effective?

  • E. Michael Foster


Over the last decade and a half, interest in the economic analysis of interventions and services to prevent or treat behavioral health problems among children and youth has grown (Aos, Lieb, Mayfield, Miller, & ­Pennucci, 2004; Foster, Jonnes, & Dodge, 2003). The need for such research has been recognized by the National Institutes of Health. For example, the National Institute of Mental Health’s (NIMH) 1996 plan for prevention research recognized this gap and stated: “Too little attention, however, has been focused on conducting cost–benefit or ­cost-effectiveness analyses that can reliably demonstrate whether preventive interventions indeed save money and improve health.” Such information is of great importance to policy makers: “cost–benefit or cost-effectiveness analyses need to become an integral part of NIMH-supported prevention effectiveness ­trials” (p. 17–18) (National Advisory Mental Health Council, 1996). However, the growth of interest has outstripped that of progress. For example, of the 23 programs in the National Institute on Drug Abuse (NIDA), “Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators and Community Leaders,” only one has been subjected to economic analysis – the ­Strengthening Families Program (Spoth, Guyll, & Day, 2002).


Conduct Problem Mental Health Service Economic Evaluation Oppositional Defiant Disorder Parent Training 
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  1. American Psychiatric Association. (1994). Diagnostic criteria from DSM-IV. Washington, D.C.: The American Psychiatric Association.Google Scholar
  2. Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth. Seattle, WA: Washington State Public Policy Institute.Google Scholar
  3. Arnold, L. E., Abikoff, H. B., Cantwell, D. P., Conners, C. K., Elliott, G., Greenhill, L. L., et al. (1997). National institute of mental health collaborative multimodal treatment study of children with ADHD (the MTA). Design challenges and choices. Arch Gen Psychiatry, 54(9), 865–870.PubMedCrossRefGoogle Scholar
  4. Barnett, W. S. (1985). The Perry preschool program and its long-term effects: A benefit–cost analysis. Ypsilanti, MI: High/Scope Educational Research Foundation.Google Scholar
  5. Barnett, W. S. (1996). Lives in the balance: Age-27 benefit–cost analysis of the High/Scope Perry Preschool Program. Ypsilanti, MI: High/Scope.Google Scholar
  6. Barnett, W. S., & Masse, L. N. (2007). Comparative benefit–cost analysis of the Abecedarian program and its policy implications. Economics of Education Review, 26(1), 113–125.CrossRefGoogle Scholar
  7. Barrera, M., Jr., Biglan, A., Taylor, T. K., Gunn, B. K., Smolkowski, K., Black, C., et al. (2002). Early elementary school intervention to reduce conduct problems: A randomized trial with Hispanic and non-Hispanic children. Prevention Science, 3, 83–94.PubMedCrossRefGoogle Scholar
  8. Belfield, C. R., Nores, M., Barnett, S., & Schweinhart, L. (2006). The High/Scope Perry Preschool Program: Cost–benefit analysis using data from the age-40 followup. Journal of Human Resources, 41(1), 162–190.Google Scholar
  9. Bor, W., Sanders, M. R., & Markie-Dadds, C. (2002). The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. Journal of Abnormal Child Psychology, 30(6), 571–587.PubMedCrossRefGoogle Scholar
  10. Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27(2), 180–189.PubMedCrossRefGoogle Scholar
  11. Briggs, A. H. (2000). Handling uncertainty in cost-effectiveness models. Pharmacoeconomics, 17, 479–500.PubMedCrossRefGoogle Scholar
  12. Briggs, A., & Fenn, P. (1998). Confidence intervals or surfaces? Uncertainty on the cost-effectiveness plane. Health Economics, 7, 723–740.PubMedCrossRefGoogle Scholar
  13. Cannon, J. S., Karoly, L. A., & Kilburn, M. R. (2001). Directions for costs and outcome analysis of starting early, staring smart: Summary of a cost expert meeting. Santa Monica, CA: Rand.Google Scholar
  14. Chambers, J., Parrish, T., Lieberman, J., & Wolman, J. (1998). What are we spending on special education in the US? CSEF brief, 8, 1–4.Google Scholar
  15. Chambers, J., Parrish, T., & Harr, J. J. (2002). What are we spending on special education in the US? 1999-2000. CSEF brief, 8, 1–4.Google Scholar
  16. Claxton, K., Lacey, L. F., & Walkter, S. G. (2000). Selecting treatments: A decision theoretic approach. Journal of the Royal Statistical Society: Series A (Statistics in Society), 163(Part 2), 211–225.CrossRefGoogle Scholar
  17. Cohen, M. A. (1998). The monetary value of saving a high-risk youth. Journal of Quantitative Criminology, 14, 5–33.CrossRefGoogle Scholar
  18. Cohen, M. A. (2005). The costs of crime and justice. New York: London.CrossRefGoogle Scholar
  19. Conduct Problems Prevention Research Group. (2007). Fast track randomized controlled trial to prevent externalizing psychiatric disorders: Findings from grades 3 to 9. Journal of the American Academy of Child and Adolescent Psychiatry, 46(10), 1250–1262.CrossRefGoogle Scholar
  20. Drake, E. (2007). Evidence-based juvenile offender programs: Program description, quality assurance, and cost. Olympia, WA: Washington State Institute for Public Policy.Google Scholar
  21. Drummond, M. F., O'Brien, B., Stoddart, G. L., & Torrance, G. W. (1997). Methods for the Economic Evaluation of Health Care Programmes (2nd ed.). New York, NY: Oxford Univeristy Press.Google Scholar
  22. Foster, E. M., & Bickman, L. (2000). Refining the costs analyses of the Fort Bragg Evaluation: The impact of cost offset and cost shifting. Mental Health Services Research, 2(1), 13–25.PubMedCrossRefGoogle Scholar
  23. Foster, E. M., & Connor, T. (2005). The public costs of better mental health services for children and adolescents. Psychiatric Services, 56, 50–55.PubMedCrossRefGoogle Scholar
  24. Foster, E. M., Jones, D. E., & Conduct Problems Prevention Research Group. (2005). The high costs of aggression: Public expenditures resulting from conduct disorder. American Journal of Public Health, 95(10), 1767–1772.CrossRefGoogle Scholar
  25. Foster, E. M., Jones, D., & Conduct Problems Prevention Research Group. (2006). Can a costly intervention be cost-effective?: An analysis of violence prevention. Archives of General Psychiatry, 63, 1284–1291.CrossRefGoogle Scholar
  26. Foster, E. M., & Jones, D. (2007). The economic analysis of prevention: An illustration involving the fast track project. Journal of Mental Health Policy and Economics, 10(4), 165–175.PubMedGoogle Scholar
  27. Foster, E. M., Jones, D., & Dodge, K. A. (2003). Issues in the economic evaluation of prevention programs. Applied Developmental Science, 7(2), 74–84.CrossRefGoogle Scholar
  28. Foster, E. M., Olchowski, A. E., & Webster-Stratton, C. H. (2007). Is stacking intervention components cost-effective? An analysis of the Incredible Years program. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1414–1424.PubMedCrossRefGoogle Scholar
  29. Foster, E. M., Porter, M. M., Ayers, T. S., Kaplan, D. L., & Sandler, I. (2007). Estimating the costs of preventive interventions. Evaluation Review, 31(3), 261–286.PubMedCrossRefGoogle Scholar
  30. Foster, E. M., Taylor, T., & Shelton-Johnson, D. (2007). Measuring time costs in psychosocial interventions: How and Why. American Journal of Community Psychology, 40(1–2), 64–81.PubMedCrossRefGoogle Scholar
  31. Gold, M. R., Russell, L. B., Siegel, J. E., & Weinstein, M. C. (Eds.). (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.Google Scholar
  32. Gorsky, R. D., Haddix, A. C., & Schaffer, P. A. (1996). Cost of an Intervention. In A. C. Haddix, S. M. Teutsch, P. A. Shaffer & D. O. Dunet (Eds.), Prevention Effectivness: A Guide to Decision Analysis and Economic Evaluation (pp. 57–75). New York: Oxford University Press.Google Scholar
  33. Hargreaves, W. A., Shumway, M., Hu, T. W., & Cuffel, B. (1998). Cost-outcome methods for mental health. New York: Academic Press.Google Scholar
  34. Hoch, J. S., Briggs, A. H., & Willan, A. R. (2002). Something old, something new, something borrowed, something blue: A framework for the marriage of health econometrics and cost-effectiveness analysis. Health Economics, 11, 415–430.PubMedCrossRefGoogle Scholar
  35. Kenkel, D. (1994). Cost of illness approach. In D. Kenkel & R. Fabian (Eds.), Valuing Health for Policy: An Economic Approach, (pp. 42–71) Chicago.Google Scholar
  36. Kusche, C., & Greenberg, M. (1993). The PATHS Curriculum. Unpublished manuscript, Seattle, WA: Developmental Research and Programs.Google Scholar
  37. Lochman, J. E., & Conduct Problems Prevention Research, G. (1995). Screening of child behavior problems for prevention programs at school entry. Journal of Consulting and Clinical Psychology, 63(4), 549–559.PubMedCrossRefGoogle Scholar
  38. Lothgren, M., & Zethraues, N. (2000). Definition, interpretation, and calculation of cost-effectiveness acceptability curves. Health Economics, 9, 623–630.PubMedCrossRefGoogle Scholar
  39. Miller, L. S., & Rojas-Flores, L. (1999). Preventing conduct problems in urban, latino preschoolers through parent training: A pilot study. New York: New York University Child Study Center.Google Scholar
  40. National Advisory Mental Health Council. (1996). A plan for prevention research for the National Institute of Mental Health. Washington, DC: National Institutes of Health, National Institute of Mental Health.Google Scholar
  41. O’Brien, B. J., & Briggs, A. H. (2002). Analysis of uncertainty in health care cost-­effectiveness studies: An introduction to statistical issues and methods. Statistical Methods in Medical Research, 11, 455–468.PubMedCrossRefGoogle Scholar
  42. Raghunathan, T. E., Lepkowski, J. M., Van Hoewyk, J., & Solenberger, P. (2001). A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodology, 27(1), 85–95.Google Scholar
  43. Reynolds, A. J., Temple, J. A., Robertson, D. L., & Mann, E. A. (2002). Age 21 cost-benefit analysis of the Title I Chicago child–parent centers. Educational Evaluation and Policy Analysis, 24(4), 267–303.CrossRefGoogle Scholar
  44. Rice, D. P., Hodgson, T. A., & Kopstein, A. N. (1985). The economic costs of illness: a replication and update. Health Care Financ Rev, 7(1), 61–80.PubMedGoogle Scholar
  45. Rice, D. P., Kelman, S., & Miller, L. S. (1991). Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep, 106(3), 280–292.PubMedGoogle Scholar
  46. Richters, J. E., Arnold, L. E., Jensen, P. S., Abikoff, H., Conners, C. K., Greenhill, L. L., et al. (1995). NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. Journal of the Amercian Academy of Child and Adolescent Psychiatry, 34(8), 987–1000.CrossRefGoogle Scholar
  47. Rosenbaum, P. R., & Rubin, D. B. (1983). The Central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.CrossRefGoogle Scholar
  48. Rosenbaum, P. R. (2002). Observational Studies. New York: Springer-Verlag.Google Scholar
  49. Rosenbaum, P. R. (2004). Design sensitivity in observational studies. Biometrika, 91(1), 153–164.CrossRefGoogle Scholar
  50. Russell, S. (1986). Is prevention better than the cure? Washington, DC: The Brookings Institution.Google Scholar
  51. Sanders, M. R. (1999). Triple P-Positive Parenting Program: Towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clinical Child and Family Psychology Review, 2(2), 71–90.PubMedCrossRefGoogle Scholar
  52. Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The triple P-positive parenting program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68(4), 624–640.PubMedCrossRefGoogle Scholar
  53. Sanders, M. R., Turner, K. M., & Markie-Dadds, C. (2002). The development and dissemination of the Triple P-Positive Parenting Program: A multilevel, evidence-based system of parenting and family support. Prevention Science, 3(3), 173–189.PubMedCrossRefGoogle Scholar
  54. Scott, S., Spender, Q., Doolan, M., Jacobs, B., & Aspland, H. (2001). Multicentre controlled trial of parenting groups for child antisocial behaviour in clinical practice. British Medical Journal, 323, 194–198.PubMedCrossRefGoogle Scholar
  55. Sendi, P. P., & Briggs, A. H. (2001). Affordability and cost-effectiveness: Decision-­making on the cost-effectiveness plane. Health Economics, 10(7), 675–680.PubMedCrossRefGoogle Scholar
  56. Shoenwald, S. K., Ward, D. M., Henggeler, S. W., Pickrel, S. G., & Patel, H. (1996). Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient and residential placement. Journal of Child and Family Studies, 5(4), 431–444.CrossRefGoogle Scholar
  57. Sobocki, P., Lekander, I., Borgstrom, F., Strom, O., & Runeson, B. (2007). The economic burden of depression in Sweden from 1997 to 2005. Eur Psychiatry, 22(3), 146–152.PubMedCrossRefGoogle Scholar
  58. Spoth, R. L., 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, 219–228.PubMedGoogle Scholar
  59. Taylor, T. K., Schmidt, F., Pepler, D., & Hodgins, H. (1998). A comparison of eclectic treatment with Webster-Stratton’s Parents and Children Series in a children’s mental health center. Behavior Therapy, 29, 221–240.CrossRefGoogle Scholar
  60. Warner, K. E., & Luce, B. R. (1982). Cost–benefit and cost-effectiveness analysis in health care. Ann Arbor, MI: Health Administration Press.Google Scholar
  61. Webster-Stratton, C. (1982). The long-term effects of a videotape modeling parent-­training program: Comparison of immediate and one-year follow-up results. Behavior Therapy, 13, 702–704.CrossRefGoogle Scholar
  62. Webster-Stratton, C. (1984). A randomized trial of two parent-training programs for families with conduct-disordered children. Journal of Consulting and Clinical Psychology, 52, 666–678.PubMedCrossRefGoogle Scholar
  63. Webster-Stratton, C. (1990). Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children. Journal of Abnormal Child Psychology, 18, 479–492.PubMedCrossRefGoogle Scholar
  64. Webster-Stratton, C. (1994). Advancing videotape parent training: A comparison study. Journal of Consulting and Clinical Psychology, 62, 583–593.PubMedCrossRefGoogle Scholar
  65. Webster-Stratton, C. (2000). The incredible years training series. Juvenile Justice Bulletin, 1–23.Google Scholar
  66. Webster-Stratton, C., & Hammond, M. (1997). Treating children with early onset-­conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93–109.PubMedCrossRefGoogle Scholar
  67. Webster-Stratton, C., Hollinsworth, T., & Kolpacoff, M. (1989). The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. Journal of Consulting and Clinical Psychology, 57, 550–553.PubMedCrossRefGoogle Scholar
  68. Webster-Stratton, C., Mihalic, S., Fagan, A., Arnold, D., Taylor, T., & Tingley, C. (2001). Blueprints for violence, book eleven: The Incredible Years Parent, Teacher, and Training Series. Boulder, CO: Center for the Study and Prevention of Violence.Google Scholar
  69. Webster-Stratton, C., & Reid, M. J. (2003). Treating conduct problems and strengthening social and emotional competence in young children: The Dina Dinosaur Treatment Program. Journal of Emotional and Behavioral Disorders, 11, 130–143.CrossRefGoogle Scholar
  70. Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: Intervention outcomes for parent, child, and teacher training. Journal of Clinical Child and Adolescent Psychology, 33, 105–124.PubMedCrossRefGoogle Scholar
  71. Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 years). Prevention Science, 2(3), 165–192.PubMedCrossRefGoogle Scholar
  72. Zerbe, R. O., Jr., & Dively, D. D. (1994). Benefit-cost analysis in theory and practice. New York: Harper Collins College Publishers.Google Scholar

Copyright information

© Springer New York 2011

Authors and Affiliations

  • E. Michael Foster
    • 1
  1. 1.University of North CarolinaChapel HillUSA

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