Purpose: : Acquaintance-initiated sexual violence is common on university campuses. Eight percent of university men self-report perpetrating at least one attempted or completed rape. Although all universities that receive federal funding are required to implement rape prevention programming, a recent meta-analysis found that the effectiveness of these programs is minimal. More troubling, the effect size for men’s programs may be close to zero. These programs often target all men on campus, and although the cost for providing the treatment is low, it may be unnecessary to direct resources to low-risk men.
Method: We used a four-year Markov model with yearly cycles to examine the cost-effectiveness of an alternative intervention strategy that would target and treat only university men at high risk for perpetrating sexual violence. The model captures cost and utility parameters including screening and program expenditure, annual probability of offending, legal costs, victim expenses (medical and mental health services), and pain and suffering estimates. The epidemiology and clinical literature was reviewed to develop baseline model assumptions. A three-way sensitivity analysis varied the cost and the effectiveness of targeted treatment, and the effectiveness of treatment as usual.
Result: The model suggested that a targeted intervention that reduced high-risk men’s annual probability of offending by only 10% (.083 to .074) is favored over treatment as usual provided the associated costs were less than $5,000 (60 times greater than the base case cost estimate of $85 per student). However, if programs targeting all men were able to achieve a 10% reduction in the probability of offending, then a treatment targeting high-risk men would be favored only if costs were low (<$400) and the program achieved at least a 25% reduction in the probability of offending.
Conclusion: A targeted intervention for high-risk men may prove to be the most cost-effective intervention within a range of plausible parameters.
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