Adopting electric school buses in the United States: Health and climate benefits.

Electric school buses have been proposed as an alternative to reduce the health and climate impacts of the current U.S. school bus fleet, of which a substantial share are highly polluting old diesel vehicles. However, the climate and health benefits of electric school buses are not well known. As they are substantially more costly than diesel buses, assessing their benefits is needed to inform policy decisions. We assess the health benefits of electric school buses in the United States from reduced adult mortality and childhood asthma onset risks due to exposure to ambient fine particulate matter (PM2.5). We also evaluate climate benefits from reduced greenhouse-gas emissions. We find that replacing the average diesel bus in the U.S. fleet in 2017 with an electric bus yields $84,200 in total benefits. Climate benefits amount to $40,400/bus, whereas health benefits amount to $43,800/bus due to 4.42*10-3 fewer PM2.5-attributable deaths ($40,000 of total) and 7.42*10-3 fewer PM2.5-attributable new childhood asthma cases ($3,700 of total). However, health benefits of electric buses vary substantially by driving location and model year (MY) of the diesel buses they replace. Replacing old, MY 2005 diesel buses in large cities yields $207,200/bus in health benefits and is likely cost-beneficial, although other policies that accelerate fleet turnover in these areas deserve consideration. Electric school buses driven in rural areas achieve small health benefits from reduced exposure to ambient PM2.5. Further research assessing benefits of reduced exposure to in-cabin air pollution among children riding buses would be valuable to inform policy decisions.

Benefit-Cost Analysis for Earthquake-Resilient Building Design and Retrofit: State of the Art and Future Research Needs.

This paper reviews the state of the art in using benefit-cost analysis (BCA) to inform earthquake risk reduction decisions by building owners and policymakers. The goal is to provide a roadmap for the application and future development of BCA methods and tools for earthquake risk reduction. Our review covers three earthquake risk reduction measures: adopting up-to-date building codes for new construction, designing new buildings to exceed code requirements, and retrofitting deficient existing buildings. We highlight the factors that influence the cost-effectiveness of building design and retrofit, as well as tactics for increasing the cost-effectiveness of risk reduction strategies. We also present BCA results, methods, and data sources used in the literature to help researchers and practitioners design and conduct a reliable and robust BCA study. In the process, we develop a set of opportunities and challenges for applying BCA to new areas of research, as well as key gaps and limitations in current BCA approaches, including further investigation of above-code design, incorporation of code implementation and enforcement into BCA, quantification of environmental benefits of seismic retrofits, and optimization of seismic retrofits with energy upgrades. Overall, our review provides practical guidance and useful insights into BCA with the goal of increasing the earthquake resilience and economic efficiency of buildings in the United States.

Health and Economic Evaluation of Vaccination Against Pertussis in China: A 40-Year Analysis.

OBJECTIVES: This study aimed to evaluate the health and economic impact of diphtheria, tetanus, whole-cell pertussis vaccine (DTwP) and diphtheria-tetanus-acellular pertussis vaccine (DTaP) vaccination on pertussis prevention and control in China during the 40 years from 1978 to 2017. METHODS: We conducted cost-benefit analyses with a decision tree model populated with historical vaccination coverage levels and pertussis incidence and mortality data from before 1978 and during 1978 to 2017. We modeled 40 birth cohorts from birth until death. Costs and benefits were estimated from direct cost and societal perspectives (direct and indirect costs). Costs and benefits were adjusted to 2017 US dollars (USD), and future values were discounted at a 3% annual rate. We calculated net benefit values (net savings) and benefit-cost ratios of pertussis vaccination of children younger than 5 years. We conducted sensitivity analyses by varying key parameters within plausible ranges. RESULTS: Without DTwP and DTaP vaccination, there would be an estimated 115.76 million pertussis cases and 426 650 pertussis deaths in the 40 cohorts. With DTwP/DTaP vaccination, pertussis cases and deaths were decreased by an estimated 92.57% and 97.43%, saving 46 987.81 million USD in direct costs and 82 013.37 million USD from societal perspective. Pertussis vaccination program costs were 2168.76 million USD and 3961.28 million USD from direct cost and societal perspectives. Benefit-cost ratios were 21.67:1 from the direct cost perspective and 20.70:1 from the societal perspective. Sensitivity analyses showed the results to be robust. CONCLUSIONS: Over the lifetime of 40 birth cohorts, China's immunization program is preventing 93% of pertussis cases and 97% of pertussis deaths, resulting in substantial savings to the healthcare system and society.

The benefits and costs of U.S. employer COVID-19 vaccine mandates.

In 2021, the Biden Administration issued mandates requiring COVID-19 vaccinations for U.S. federal employees and contractors and for some healthcare and private sector workers. These mandates have been challenged in court; some have been halted or delayed. However, their costs and benefits have not been rigorously appraised. This study helps fill that gap. We estimate the direct costs and health-related benefits that would have accrued if these vaccination requirements had been implemented as intended. Compared with the January 2022 vaccination rates, we find that the mandates could have led to 15 million additional vaccinated individuals, increasing the overall proportion of the fully vaccinated U.S. population from 64% to 68%. The associated net benefits depend on the subsequent evolution of the pandemic-information unavailable ex ante to analysts or policymakers. In scenarios involving the emergence of a novel, more transmissible variant, against which vaccination and previous infection offer moderate protection, the estimated net benefits are potentially large. They reach almost $20,000 per additional vaccinated individual, with more than 20,000 total deaths averted over the 6-month period assessed. In scenarios involving a fading pandemic, existing vaccination-acquired or infection-acquired immunity provides sufficient protection, and the mandates' benefits are unlikely to exceed their costs. Thus, mandates may be most useful when the consequences of inaction are catastrophic. However, we do not compare the effects of mandates with alternative policies for increasing vaccination rates or for promoting other protective measures, which may receive stronger public support and be less likely to be overturned by litigation.

Benefit-cost analysis of becoming certified pollinator friendly.

Despite significant drop in pollinator abundance, no studies exist on the benefits and costs of pollinator conservation in the public domain. An in-person survey was conducted at three large, public US universities to estimate benefits to become Bee Campus USA certified. We test whether different types of reminders on existing student sustainability fees affect Willingness to Pay. Costs of achieving this certification per university were obtained. Net Present Value demonstrates that the net benefits to each school are largely positive, except under the most restrictive assumption. Information reminders of existing fees lead to little change in support of pollinator conservation.

Exploring epidemic voluntary vaccinating behavior based on information-driven decisions and benefit-cost analysis.

A complex dynamic interplay exists between epidemic transmission and vaccination, which is significantly influenced by human behavioral responses. We construct a research framework combining both the function modeling of the cumulative global COVID-19 information and limited individuals' information processing capacity employing the Gompertz model for growing processes. Meanwhile, we built a function representing the decision to get vaccinated following benefit-cost analysis considered the choices made by people in each scenario have an influence from altruism, free-riding and immunity escaping capacity. Through the mean-field calculation analysis and using a fourth-order Runge-Kutta method with constant step size, we obtain plots from numerical simulations. We found that only when the total number of infectious individuals proves sufficient to reach and exceed a certain level will the individuals face a better trade-off in determining whether to get vaccinated against the diseases based on that information. Besides, authoritative media have a higher decisive influence and efforts should be focused on extending the duration of vaccine protection, which is beneficial to inhibit the outbreaks of epidemics. Our work elucidates that reducing the negative payoff brought about by the free-riding behavior for individuals or improving the positive payoff from the altruistic motivation helps to control the disease in cultures that value social benefits, vaccination willingness is generally stronger. We also note that at a high risk of infection, the decision of vaccination is highly correlated with global epidemic information concerning COVID-19 infection, while at times of lower risk, it depends on the game theoretic vaccine strategy. The findings demonstrate that improving health literacy, ensuring open and transparent information on vaccine safety and efficacy as a public health priority can be an effective strategy for mitigating inequalities in health education, as well as alleviating the phenomenon that immunity escaping abilities is more likely to panic by populations with high levels of education. In addition, prosocial nudges are great ways to bridge these immunity gaps that can contribute to implementing government public health control measures, creating a positive feedback loop.

Economic analysis of financial incentives for smoking cessation during pregnancy and postpartum.

Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.

Quantification and characterization of recovered materials in the cycle of the informal household electronic waste dismantling in Buriram province, Thailand: A challenge towards sustainable management and circular economy.

The numerous amount of electronic waste (e-waste) has not been managed effectively resulting informal dismantling sites are being expanded in Thailand. The government attempts to improve the efficiency of an integrated e-waste management system, but baseline data of e-waste stream in informal sectors are insufficient. This research aimed to investigate the inflow and outflow of the materials throughout the informal e-waste dismantling processes at the well-known second-largest community in Buriram province during 2017-2018. To describe the quantities of dismantled materials, a material flow analysis was performed. The overall amount of e-waste taken to the community was estimated to be in the range of 1593-12,943 tonnes year-1. Valuable materials could be recovered at more than 90% (by mass) from fans, refrigerators, washing machines, microwaves and air conditioners. The amount of e-waste residue that the local administrative organization had to handle was up to 1144 tonnes year-1. The quantitative data retrieved from this study could provide a satisfactory equation for estimating the amount of separated valuable and non-valuable materials. Recyclable materials from dismantling have an economic incentive, e-waste dismantlers in a small and large household group that can earn approximately 798 and 1262 USD month-1 income, respectively. The notable e-waste characterization and quantification of recovered materials would be useful for improving the potential circular flow of e-waste in Thailand.

Approaches for estimating benefits and costs of interventions in plant biosecurity across invasion phases.

Nonnative plant pests cause billions of dollars in damages. It is critical to prevent or reduce these losses by intervening at various stages of the invasion process, including pathway risk management (to prevent pest arrival), surveillance and eradication (to counter establishment), and management of established pests (to limit damages). Quantifying benefits and costs of these interventions is important to justify and prioritize investments and to inform biosecurity policy. However, approaches for these estimations differ in (1) the assumed relationship between supply, demand, and prices, and (2) the ability to assess different types of direct and indirect costs at invasion stages, for a given arrival or establishment probability. Here we review economic approaches available to estimate benefits and costs of biosecurity interventions to inform the appropriate selection of approaches. In doing so, we complement previous studies and reviews on estimates of damages from invasive species by considering the influence of economic and methodological assumptions. Cost accounting is suitable for rapid decisions, specific impacts, and simple methodological assumptions but fails to account for feedbacks, such as market adjustments, and may overestimate long-term economic impacts. Partial equilibrium models consider changes in consumer and producer surplus due to pest impacts or interventions and can account for feedbacks in affected sectors but require specialized economic models, comprehensive data sets, and estimates of commodity supply and demand curves. More intensive computable general equilibrium models can account for feedbacks across entire economies, including capital and labor, and linkages among these. The two major considerations in choosing an approach are (1) the goals of the analysis (e.g., consideration of a single pest or intervention with a limited range of impacts vs. multiple interventions, pests or sectors), and (2) the resources available for analysis such as knowledge, budget and time.

The Benefits and Costs of Cybersecurity Risk Reduction: A Dynamic Extension of the Gordon and Loeb Model.

This article develops a dynamic extension of the classic model of cybersecurity investment formulated by Gordon and Loeb. In this dynamic model, results are influenced by the rate at which cybersecurity assets depreciate and the rate of return on investment. Depreciation costs are lower in the dynamic model than is implicitly assumed in the classic model, while the rate-of-return threshold is higher. On balance, the user cost of cybersecurity assets is lower in the dynamic model than is implicitly assumed in the classic model. This difference increases the economically efficient size of the cybersecurity system in value terms, increasing the efficient level of risk reduction.

Recent Advances in Probabilistic Dose-Response Assessment to Inform Risk-Based Decision Making.

Paradoxically, risk assessments for the majority of chemicals lack any quantitative characterization as to the likelihood, incidence, or severity of the risks involved. The relatively few cases where "risk" is truly quantified are based on either epidemiologic data or extrapolation of experimental animal cancer bioassay data. The paucity of chemicals and health endpoints for which such data are available severely limits the ability of decisionmakers to account for the impacts of chemical exposures on human health. The development by the World Health Organization International Programme on Chemical Safety (WHO/IPCS) in 2014 of a comprehensive framework for probabilistic dose-response assessment has opened the door to a myriad of potential advances to better support decision making. Building on the pioneering work of Evans, Hattis, and Slob from the 1990s, the WHO/IPCS framework provides both a firm conceptual foundation as well as practical implementation tools to simultaneously assess uncertainty, variability, and severity of effect as a function of exposure. Moreover, such approaches do not depend on the availability of epidemiologic data, nor are they limited to cancer endpoints. Recent work has demonstrated the broad feasibility of such approaches in order to estimate the functional relationship between exposure level and the incidence or severity of health effects. While challenges remain, such as better characterization of the relationship between endpoints observed in experimental animal or in vitro studies and human health effects, the WHO/IPCS framework provides a strong basis for expanding the breadth of risk management decision contexts supported by chemical risk assessment.

Introduction to Special Issue on Risk Assessment, Economic Evaluation, and Decisions.

Integrating risk assessment, economic evaluation, and uncertainty to inform policy decisions is a core challenge to risk analysis. In September 2019, the Harvard Center for Risk Analysis, with support from the Society for Risk Analysis Economics and Benefits Analysis Specialty Group and others, convened a workshop to address this issue. The workshop built in part on the recommendations of the 2009 National Research Council report, Science and Decisions: Advancing Risk Assessment. It honored John S. Evans, whose thoughtful and innovative teaching and scholarship have significantly advanced thinking on these issues. This special issue features a profile of Dr. Evans and nine articles that build on work presented at the workshop.

Do the Benefits of COVID-19 Policies Exceed the Costs? Exploring Uncertainties in the Age-VSL Relationship.

Numerous analyses of the benefits and costs of COVID-19 policies have been completed quickly as the crisis has unfolded. The results often largely depend on the approach used to value mortality risk reductions, typically expressed as the value per statistical life (VSL). Many analyses rely on a population-average VSL estimate; some adjust VSL for life expectancy at the age of death. We explore the implications of theory and empirical studies, which suggest that the relationship between age and VSL is uncertain. We compare the effects of three approaches: (1) an invariant population-average VSL; (2) a constant value per statistical life-year (VSLY); and (3) a VSL that follows an inverse-U pattern, peaking in middle age. We find that when applied to the U.S. age distribution of COVID-19 deaths, these approaches result in average VSL estimates of $10.63 million, $4.47 million, and $8.31 million. We explore the extent to which applying these estimates alters the conclusions of frequently cited analyses of social distancing, finding that they significantly affect the findings. However, these analyses do not address other characteristics of COVID-19 deaths that may increase or decrease the VSL estimates. Examples include the health status and income level of those affected, the size of the risk change, and the extent to which the risk is dreaded, uncertain, involuntarily incurred, and outside of one's control. The effects of these characteristics and their correlation with age are uncertain; it is unclear whether they amplify or diminish the effects of age on VSL.

Long-term Impacts and Benefit-Cost Analysis of the Communities That Care Prevention System at Age 23, 12 Years After Baseline.

This study estimated sustained impacts and long-term benefits and costs of the Communities That Care (CTC) prevention system, implemented and evaluated in a longitudinal cluster-randomized trial involving 24 communities in seven states. Analyses utilized reports from a longitudinal panel of 4407 participants, followed since the study's baseline in grade 5, with most recent follow-up 12 years later at age 23. Impacts on lifetime abstinence from primary outcomes of substance use and antisocial behavior were estimated using generalized linear mixed Poisson regression analysis, adjusted for individual and community-level covariates. Possible cascading effects on 4-year college completion, major depressive disorder, and generalized anxiety disorder through age 23 were evaluated as secondary outcomes. CTC had a statistically significant global effect on primary outcomes and also on combined primary and secondary outcomes. Among primary outcomes, point estimates suggested absolute improvements in lifetime abstinence of 3.5 to 6.1% in the intervention arm and relative improvements of 13 to 55%; 95% confidence intervals revealed some uncertainty in estimates. Among secondary outcomes, 4-year college completion was 1.9% greater among young adults from intervention communities, a 20% relative improvement. Mental health outcomes were approximately the same across trial arms. Although CTC had small sustained effects through age 23, benefit-cost analyses indicated CTC was reliably cost beneficial, with a net present value of $7152 (95% credible interval: $1253 to $15,268) per participant from primary impacts and $17,919 ($306 to $39,186) when secondary impacts were also included. It remained cost beneficial even when impacts were adjusted downward due to the involvement of CTC's developer in the trial. Findings suggest that broader dissemination of CTC could improve public health and individual lives in the long term and generate positive net benefits to society.

Quantifying the social benefits and costs of reducing phosphorus pollution under climate change.

Excess phosphorus loading to waterbodies has led to increasing frequency and severity of harmful algal blooms, negatively impacting economic activity and human health. While interventions to improve water quality can create large societal benefits, these investments are costly and the value of benefits is often unknown. Understanding the social and economic impacts of reduced phosphorus loading is critical for developing effective land use policies and for generating public and political support for these initiatives. Here, we quantify the social benefits and costs of improving water quality in Lake Champlain under a range of phosphorus reduction and climate change scenarios between 2016 and 2050. We use statistical models to link water quality outputs from an established integrated assessment model with three categories of benefits: tourism expenditures, property sales, and avoided human health impacts. We estimate the costs of reducing phosphorus loading using data reported by the State of Vermont. We find that under the most aggressive phosphorus reduction scenario, the total benefits of improved water quality are $55 to $60 million between 2016 and 2050. Over this 35 year time horizon, the combined benefits do not outweigh the costs under any scenario. If the time horizon is extended to 2100 or beyond, however, the benefits may exceed the costs if the applied discount rate is less than 3%. Importantly, we almost certainly underestimate the value of clean water, due to the omission of other types of benefits. Despite this uncertainty, our study provides a tractable framework for disentangling the complex relationships between water quality and human well-being, and illuminates the value of reductions in phosphorus loading to society.

Decreasing smoking during pregnancy: Potential economic benefit of reducing sudden unexpected infant death.

Sudden Unexpected Infant Death (SUID) remains the leading cause of death among U.S. infants age 1-12 months. Extensive epidemiological evidence documents maternal prenatal cigarette smoking as a major risk factor for SUID, but leaves unclear whether quitting reduces risk. This Commentary draws attention to a report by Anderson et al. (Pediatrics. 2019, 143[4]) that represents a breakthrough on this question and uses their data on SUID risk reduction to delineate potential economic benefits. Using a five-year (2007-11) U.S. CDC Birth Cohort Linked Birth/Infant Death dataset, Anderson et al. demonstrated that compared to those who continued smoking, women who quit or reduced smoking by third trimester decreased the adjusted odds of SUID risk by 23% (95% CI, 13%-33%) and 12% (95% CI, 2%-21%), respectively. We applied these reductions to the U.S. Department of Health and Human Services' recommended value of a statistical life in 2020 ($10.1 million). Compared to continued smoking during pregnancy, the economic benefits per woman of quitting or reducing smoking are $4700 (95% CI $2700-$6800) and $2500 (95% CI, $400-$4300), respectively. While the U.S. obtained aggregate annual economic benefits of $0.58 (95% CI, 0.35-0.82) billion from pregnant women who quit or reduced smoking, it missed an additional $1.16 (95%CI 0.71-1.60) billion from the women who continued smoking. Delineating the health and economic impacts of decreasing smoking during pregnancy using large epidemiological studies like Anderson et al. is critically important for conducting meaningful economic analyses of the benefits-costs of developing more effective interventions for decreasing smoking during pregnancy.

Spatially resolved air-water emissions tradeoffs improve regulatory impact analyses for electricity generation.

Coal-fired power plants (CFPPs) generate air, water, and solids emissions that impose substantial human health, environmental, and climate change (HEC) damages. This work demonstrates the importance of accounting for cross-media emissions tradeoffs, plant and regional emissions factors, and spatially variation in the marginal damages of air emissions when performing regulatory impact analyses for electric power generation. As a case study, we assess the benefits and costs of treating wet flue gas desulfurization (FGD) wastewater at US CFPPs using the two best available treatment technology options specified in the 2015 Effluent Limitation Guidelines (ELGs). We perform a life-cycle inventory of electricity and chemical inputs to FGD wastewater treatment processes and quantify the marginal HEC damages of associated air emissions. We combine these spatially resolved damage estimates with Environmental Protection Agency estimates of water quality benefits, fuel-switching benefits, and regulatory compliance costs. We estimate that the ELGs will impose average net costs of $3.01 per cubic meter for chemical precipitation and biological wastewater treatment and $11.26 per cubic meter for zero-liquid discharge wastewater treatment (expected cost-benefit ratios of 1.8 and 1.7, respectively), with damages concentrated in regions containing a high fraction of coal generation or a large chemical manufacturing industry. Findings of net cost for FGD wastewater treatment are robust to uncertainty in auxiliary power source, location of chemical manufacturing, and binding air emissions limits in noncompliant regions, among other variables. Future regulatory design will minimize compliance costs and HEC tradeoffs by regulating air, water, and solids emissions simultaneously and performing regulatory assessments that account for spatial variation in emissions impacts.

Assessing the Benefits and Costs of Homeland Security Research: A Risk-Informed Methodology with Applications for the U.S. Coast Guard.

This article describes a methodology for risk-informed benefit-cost analyses of homeland security research products. The methodology is field-tested with 10 research products developed for the U.S. Coast Guard. Risk-informed benefit-cost analysis is a tool for risk management that integrates elements of risk analysis, decision analysis, and benefit-cost analysis. The cost analysis methodology includes a full-cost accounting of research projects, starting with initial fundamental research costs and extending to the costs of implementation of the research products and, where applicable, training, maintenance, and upgrade costs. The benefits analysis methodology is driven by changes in costs and risks leading to five alternative models: cost savings at the same level of security, increased security at the same cost, signal detection improvements, risk reduction by deterrence, and value of information. The U.S. Coast Guard staff selected 10 research projects to test and generalize the methodology. Examples include tools to improve the detection of explosives, reduce the costs of harbor patrols, and provide better predictions of hurricane wind speeds and floods. Benefits models and estimates varied by research project and many input parameters of the benefit estimates were highly uncertain, so risk analysis for sensitivity testing and simulation was important. Aggregating across the 10 research products, we found an overall median net present value of about $385 million, with a range from $54 million (5th percentile) to $877 million (95th percentile). Lessons learned are provided for future applications.

An Economic Evaluation of the Costs and Benefits of Providing Comprehensive Supports to Students in Elementary School.

There is growing evidence that out-of-school factors, such as physical and mental health, family support, and social and emotional development, significantly affect student learning (Berliner 2009). To address challenges related to poverty, schools are being charged with serving as a focal point in providing and coordinating support services for students and their families (Adelman and Taylor 2002; Dryfoos 2002). In many schools these support services are provided in fragmented ways that do not address the needs of all students or engage teachers in connecting these services to the academic mission of the school (Walsh and DePaul 2008). An emerging school-based model, broadly termed "comprehensive student support" (Walsh et al. 2016), is designed to overcome such fragmentation. In this paper, we build upon previous effectiveness work with an economic evaluation of a successful support model, City Connects. We find that the benefits of the program exceed the costs, indicating that the program is a sound investment and should be considered an option to address the needs of students and to prevent future crises from disrupting their learning.

Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems.

Economic models to inform decision-making are gaining popularity, especially for preventive interventions. However, there are few estimates of the long-term returns to parenting interventions used to prevent mental health problems in children. Using data from a randomised controlled trial evaluating five indicated parenting interventions for parents of children aged 5-12, we modeled the economic returns resulting from reduced costs in the health care and education sector, and increased long-term productivity in a Swedish setting. Analyses done on the original trial population, and on various sized local community populations indicated positive benefit-cost ratios. Even smaller local authorities would financially break-even, thus interventions were of good value-for-money. Benefit-cost analyses of such interventions may improve the basis for resource allocation within local decision-making.