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Washington State Institute for Public Policy
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Infant Health and Development Program (IHDP)

Public Health & Prevention: Home- or Family-based
Benefit-cost methods last updated December 2023.  Literature review updated August 2017.
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The Infant Health and Development Program (IHDP) is an early intervention program for preterm (< 37 weeks gestation), low birthweight (< 2,500 grams) infants that aims to improve children’s cognitive and behavioral outcomes. This three-year intervention includes home visits, weekday attendance at an educational child day care program, and bimonthly parent group meetings. In the included study, all participants in the treatment and comparison groups received pediatric follow-up services (treatment as usual).
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $6,259 Benefits minus costs ($39,607)
Participants $13,622 Benefit to cost ratio $0.15
Others $10,109 Chance the program will produce
Indirect ($22,952) benefits greater than the costs 23%
Total benefits $7,038
Net program cost ($46,645)
Benefits minus cost ($39,607)

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
25 Primary 2 334 -0.100 0.287 33 0.000 0.000 34 -0.100 0.728
25 Primary 1 307 0.116 0.135 28 0.116 0.135 28 0.116 0.390
1 Secondary 1 338 -0.044 0.229 8 -0.044 0.229 8 -0.044 0.849
1 Secondary 1 338 -0.112 0.209 8 -0.112 0.209 8 -0.112 0.592
1 Secondary 2 239 0.200 0.084 17 0.200 0.084 17 0.200 0.017
1 Secondary 2 347 0.506 0.184 3 n/a n/a n/a 0.506 0.006
1 Secondary 2 334 -0.001 0.107 8 0.000 0.064 11 -0.001 0.996
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Public assistance Public assistance ($1,702) $621 $0 ($851) ($1,932)
Employment Labor market earnings ($2,623) ($6,179) $0 $0 ($8,802)
Subtotals ($4,325) ($5,558) $0 ($851) ($10,734)
From secondary participant
Test scores Labor market earnings associated with test scores $8,142 $19,179 $10,109 $0 $37,430
K-12 grade repetition K-12 grade repetition $58 $0 $0 $29 $87
K-12 special education K-12 special education $2,384 $0 $0 $1,192 $3,575
Disruptive behavior disorder symptoms Criminal justice system $0 $0 $0 $0 $0
Health care associated with disruptive behavior disorder $1 $0 $1 $0 $2
Subtotals $10,584 $19,180 $10,109 $1,221 $41,094
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($23,322) ($23,322)
Totals $6,259 $13,622 $10,109 ($22,952) $7,038
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $13,636 2016 Present value of net program costs (in 2022 dollars) ($46,645)
Comparison costs $0 2016 Cost range (+ or -) 25%
The per-participant cost represents the average annual cost over the three-year program. The annual cost estimate relies on a per-child cost for the third year of implementation at the Miami site (Gross et al., 1997). This estimate includes costs for personnel, operations (e.g., equipment and materials), day care meals, and transportation. WSIPP applied the year 3 estimate to year 2 of IHDP, given programmatic similarity. Year 1 of the IHDP was substantially different from years 2 and 3; while it did not contain the day care component, home visiting occurred twice as frequently. WSIPP thus constructed an estimate for year-1 costs based on relevant year-3 operational and personnel costs, corrected for the increased frequency of home visiting. The total estimate was multiplied by 0.75, based on the reported 75% fidelity to the home visiting component.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Brooks-Gunn, J., McCormick, M.C., Shapiro, S., Benasich, A.A., & Black, G.W. (1994). The effects of early education intervention on maternal employment, public assistance, and health insurance: The Infant Health and Development Program. American Journal of Public Health, 84(6), 924-931.

Gross, R.T., Spiker, D., & Haynes, C.W. (1997). Helping low birth weight, premature babies: The infant health and development program. Stanford, Calif: Stanford University Press.

Infant Health and Development Program. (1990). Enhancing the outcomes of low-birth-weight, premature infants: A multisite, randomized trial. Journal of the American Medical Association, 263(22), 3035-3042.

Martin, A., Brooks-Gunn, J., Klebanov, P., Buka, S.L., & McCormick, M.C. (2008). Long-term maternal effects of early childhood intervention: Findings from the Infant Health and Development Program (IHDP). Journal of Applied Developmental Psychology, 29(2), 101-117.

McCarton, C.M., Brooks-Gunn, J., Wallace, I.F., Bauer, C.R., Bennett, F.C., Bernbaum, J.C., Broyles, S., Casey, P.H., McCormick, M.C., Scott, D.T., Tyson, J., & Tonascia, C.M. (1997). Results at age 8 years of early intervention for low-birth-weight premature infants: The Infant Health and Development Program. Journal of the American Medical Association, 277(2), 126-132.

McCormick, M.C., Brooks-Gunn, J., Buka, S.L., Goldman, J., Yu, J., Salganik, M., Scott, D.T., Bennett, F.C., Kay, L.L., Bernbaum, J.C., Bauer, C.R., Martin, C., Woods, E.R., Martin, A., & Casey, P.H. (2006). Early intervention in low birth weight premature infants: Results at 18 years of age for the infant health and development program. Pediatrics, 117(3), 771-780.