11 Cost Effectiveness in Preventing Crime  Jan van Busschbach, Djøra Soeteman  Viersprong Institute for studies on Personality Disorders VISPD  Erasmus MC Department of Medical Psychology and Psychotherapy

2 Reputation health economics

3 Reputation  Health economics….it is all about budgets…  “We didn’t actually overspend the budget….The Health Commission allocation simply fell short of our expenditure” (Keith Davis)

4 Health economics ≠ budget  It is more about what you can do, given a (fixed) budget…  Trade-off between effects  Given your budget

5 Do economics help….?  Te aim of a car is “transportation”  Cost effectiveness = Cost / km 5 Jeep Grand Cherokee 4.7….€ 1,143 per km (2006) Suzuki New Alto d glx Cool….. € 0.259

6 Cost effectiveness does not predict allocation….  Either  Cost effectiveness is invalid…  or discussion about the aim of the interventions The definition of the effects….  The effects are most often discussed  Not the budget calculations  Therefore guidelines  To obtain compatibility… 6

7 Few cost effectiveness studies  According to guidelines about a dozen  Non in The Netherlands  Welsh & Farrington, 2000  A review of the literature revealed only seven [7] published studies that have presented information on monetary costs and benefits.  McDougall et al., 2003  A systematic review of the literature revealed only nine [9] published studies that fit the criteria of the review.  Swaray et al., 2005  “10 studies fit the criteria of the review”

8 Build cost benefit studies on the basis of effect studies…. Steve Aos, Robert Barnoski, Roxanne Lieb

9 What they did….

10 16 interventions  Tax payer perspective  5 losses  11 gains  Societal perspective  3 losses  13 gains

11 Confirmation by formal Cost effectiveness studies The public costs and benefits per participant of the High/Scope Perry Preschool Study (Schweinhart, 2003).

12 Why seek further…  Interventions seem cost effective…  In terms of monetary cost benefit  What is the point of not implementing…?

13 Are we overlooking societal relevant outcomes…. 13 Jeep Grand Cherokee 4.7….€ 1,143 per km (2006) Suzuki New Alto d glx Cool….. € 0.259

14 Are we overlooking societal relevant outcomes?  Revenge (Genoegdoening)  What is the price of losing societal revenge….  If overlooked, cost effectiveness of alternatives are too optimistic  Do we agree what the effects of prevention should be?  If not….how can we determine cost effectiveness?  The question of economics is not technical…but fundamental

15 Not restricted to crime prevention in youth  Prevention in smoking costs money  When only valuing cost items…  As in diabetes etc  But the aim of prevention is to increase life expectation…  So value the increase of live expectation… “The aim of health care is not to save money but to save people from preventable suffering and death. Any potential savings on health care costs would be icing on the cake….” (Bonneux et al., 1998)

16 What is the value of life?

17 What is the value of life?

18 Or make life years the effect….  Cost per life year gained  Cost per quality of life adjusted year (QALY)

19 Generic outcomes  If we want to compare quite different treatment options…  Detention  Family Coaching  We can not use treatment specific outcomes  Numbers of days in jail  Family cohesion  Generic outcomes  That are relevant for both  That are relevant for the policy question

20 What are good generic outcomes in crime prevention?  Well….  Asking the question is answering it…  Crime! Cost per crime avoided Open for debate Quality of crime?  Treatment specific outcomes….  Like family cohesions  Might be relevant for the treatment  Are popular in scientists  But are of limited relevance for policy making….

21 Conclusion  The odds are favorable  Many alternatives are expensive  Many alternatives are ineffective  Choose societal relevant outcomes  Contains a fundamental discussion about the aim of prevention….  My favorite: Crime prevention