An Overview of Cost-Benefit Evaluations

Nurse-Family Partnership Program

Synopsis of the Work: In 1979, the Robert Wood Johnson Foundation supported a demonstration project in Elmira, N.Y., that used registered nurses to take preventive health services into the homes of young, low-income pregnant women and first-time mothers. Randomized controlled trials conducted in Elmira and subsequently Memphis, Tenn., and Denver showed the home visits yielded positive health and developmental outcomes for children and mothers. After two decades of research, David L. Olds, Ph.D., architect of the Nurse-Family Partnership Program (April 1999 to April 2008), initiated a national program to replicate the model across the country.

Four outside organizations evaluated the program.

Key Findings:

  • A 1998 Rand study estimated the cost of the visitation program for each high-risk Elmira family was $6,083 (in 1996 dollars) and projected that over time government would save $24,694 per high-risk family—a net savings of $18,611.
  • A 2004 study by the Washington State Institute for Public Policy (the research arm of the Washington state legislature) estimated per-youth costs for the Nurse-Family Partnership program were $9,118 and its per-youth benefits $26,298—a difference of $17,180.
  • A 2005 RAND study concluded that well-designed programs for disadvantaged children age 4 and younger could produce $1.26 to $17 in benefits for each $1 in program expenses.
  • A 2007 report from the Brookings Institution found that an investment in Nurse-Family Partnership would have a positive cost-benefit return for society as a whole and—with one exception—for government specifically. The exception was that for low-risk families, as studied in the Elmira trial, government would recoup only 70 cents in savings for each $1 of program costs.