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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

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Reputation health economics

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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)

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Health economics ≠ budget

It is more about what you can do, given a (fixed) budget…

Trade-off between effects Given your budget

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Do economics help….? Te aim of a car is “transportation”

Cost effectiveness = Cost / km

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Jeep Grand Cherokee 4.7….€ 1,143 per km (2006)

Suzuki New Alto 1.1 5-d glx Cool….. € 0.259

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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…

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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”

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Build cost benefit studies on the basis of effect studies….

www.wsipp.wa.gov/pub.asp?docid=98-01-1201Steve Aos, Robert Barnoski, Roxanne Lieb

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What they did….

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16 interventions

Tax payer perspective 5 losses

11 gains

Societal perspective 3 losses

13 gains

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Confirmation by formal Cost effectiveness studies

The public costs and benefits per participant of the High/Scope Perry Preschool Study (Schweinhart, 2003).

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Why seek further…

Interventions seem cost effective… In terms of monetary cost benefit

What is the point of not implementing…?

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Are we overlooking societal relevant outcomes….

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Jeep Grand Cherokee 4.7….€ 1,143 per km (2006)

Suzuki New Alto 1.1 5-d glx Cool….. € 0.259

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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

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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)

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What is the value of life?

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What is the value of life?

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Or make life years the effect….

Cost per life year gained Cost per quality of life adjusted year (QALY)

1980[pdat] AND (QALY or QALYs)

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100

200

300

400

500

600

1980 1985 1990 1995 2000 2005 2010

Pu

blic

ati

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s

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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

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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….

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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