1 Cost Effectiveness  Jan J.V. Busschbach, Ph.D.  Viersprong Institute for studies on Personality Disorders VISPD  Erasmus MC  Institute for Medical Psychology and Psychotherapy

2 (Health) Economics  Comparing different allocations  In health care: Should we spent our money on Wheel chairs Screening for cancer  Intervention in youth Jail Cure Prevention

3 Assumptions  Agreement on the budget  Assumption of scarcity  Agreement on outcome  What are the intended effects  Possible to moves between budgets

4 Economics in policy  Economics in policy are often  Only Better effects for the same (or less) money “Doelmatigheid”  Efficiency improvement  Budget impact

5 Car economics  Should we spend our money on a  Suzuki Alto 1.0  BMW 316

6 Car economics  Cost effectiveness  Comparing costs  Comparing outcome  Relate costs to outcome  Cost per outcome  Cost per kilometer

7 League Table

8 Assumptions  Agreement on the budget  Assumption of scarcity  Possible to moves between budgets  We can buy a Suzkie or a BMW  Agreement on outcome  What are the intended effects  The effects is restricted to ‘movement’

9 Which costs included in CE youth intervention?  Costs of intervention  Costs of alternatives  Jail  Other treatment  Costs of crime  Material costs  Cost of law enforcement  Other savings  Broken education  Intangible costs

10 Intangible costs  What are the costs of  Death  Suffering  Rape  Fear  No clear methodology  Willingness to pay

11 Which outcomes in youth interventions?  What is the aim of youth interventions?  Costs per avoided crime  Costs per contact  Prevention

12 Effects expressed as costs  Cost Benefit analysis  Effects can now be subtracted from costs

13 Drivers in health economics  The effect of the intervention  The cost of the intervention  Intangible costs  Discounting

14 Changes of economics in youth interventions  The effect of the intervention  The cost of the intervention  Alternative is expensive: Jail  Intangible costs  The effects are warranted  Broken education  Discounting  Sometime immediate effects

15 Threats of economics in youth interventions  The effect of the intervention  Low quality evidence on the effectiveness  A randomized trials is now the standard  The cost of the intervention  Expensive labour-intensive  Intangible costs  No consensus about these costs  Discounting  Often effect are in the further: prevention

16 Examples  The Washington State Institute for Public Policy  Steve Aos, 2004  Taxpayer perspective: cost benefit analysis  Intangible costs used as effects (sexual abuse = $ 94,506)  The monetary value of saving a high-risk youth  Cohen, 1998  Intangible costs: lifetime costs criminal career

17 Little studies  Welsh & Farrington, 2000  “[…] little is known about the economic efficiency of correctional intervention strategies. A review of the literature revealed only seven published studies that have presented information on monetary costs and benefits”.  Swaray et al, 2005  Found only 10 studies  The norm ‘evidence based’ is not near  Research dominated by aetiology and epidemiology

18 Encouraging results  Reviews show favorable results  Cure is more cost effective than prevention Targeted prevention works better  Cure more cost effective than incarceration  No Dutch evidence  Although The Netherlands is leading in health economics

19 Conclusion  Economics are lacking  Main obstacles  Convincible effect studies  The odds are favorable