Benefit-Cost Analysis of Communities That Care Outcomes through Grade 12

Introduction: Economic analyses of prevention programs and systems are needed to support sound investment of limited resources. We evaluated whether the Communities That Care (CTC) prevention system was cost-beneficial using data from a longitudinal panel of 4407 youth participating in a randomized controlled trial of CTC that included 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. At baseline there were no significant differences in youth or communities on socio-demographic and economic variables. Through grade 12, youth exposed to CTC reported significantly lower rates of initiation of delinquency, alcohol use, and tobacco use. We used benefit-cost analysis to assess whether the economic benefits from these outcomes exceeded the economic costs of achieving them.

Methods: CTC intervention costs consisted of CTC coalition costs; prevention program costs; training, technical assistance, and monitoring costs; and in-kind contributions and donations. We calculated an average CTC cost per youth across the 12 CTC communities weighted by the population of youth ages 10-14 exposed to CTC. Several major sources of economic benefit were assessed. CTC’s effect on delinquency initiation was estimated to reduce criminal justice system and victimization costs and to indirectly increase high school graduation rates, leading to higher lifetime earnings, higher taxes, and lower health care costs. Effects on alcohol use and cigarette smoking initiation were estimated to reduce, respectively, the lifetime prevalence of alcohol use disorders and heavy regular smoking, increasing earnings and tax payments, lowering health care costs, and lowering property loss (alcohol use disorder only). We estimated total long-term economic benefits per youth across all three outcomes, including benefits to participants, taxpayers, and others. We ran 1000 Monte Carlo simulations to incorporate uncertainty in measurement of costs, benefits, and model assumptions in our final estimates.

Results: CTC was estimated to produce $4477 (95% CI [$4413; $4450]) in benefits per youth (discounted 2011 dollars). It cost $556 ([$551; $561]) per youth to implement CTC for 5 years. The net present benefit was $3920 ([$3857; $3984]). The benefit-cost ratio was $8.22 ([$8.08; $8.36]) per dollar invested. The internal rate of return was 21%. Investment exceeded benefits in 100% of the 1000 Monte Carlo simulations. Investment was estimated to be recouped within 9 years. Sensitivity analyses in which effects were halved to account for developer involvement in the intervention yielded positive cost-beneficial results.

Conclusion: CTC is a low-risk, cost-beneficial public health approach to preventing initiation of delinquency, alcohol use, and tobacco use in youth.