Breakthrough RESEARCH developed three models to demonstrate the value of social and behavior change (SBC) investments for family planning (FP), malaria prevention, care seeking and treatment adherence, and breastfeeding/complementary feeding. Three areas of the literature were synthesized: the impact of SBC interventions on intermediate determinants (e.g., self-efficacy) and behavioral outcomes, the impact of intermediate determinants on behavioral outcomes, and SBC intervention costs. For each model, illustrative five-year SBC investment scenarios were generated based on country SBC program documentation and consultations with in-country partners. The models calculated the cost of SBC investments, expected change in behaviors, and the corresponding number of disability-adjusted life years (DALYs) averted. The cost per DALY averted was then compared to the country's gross domestic product (GDP) per capita, where a value below one times the GDP per capita is considered "highly cost-effective" based on World Health Organization guidelines. In total, 564 studies were used in the development of the business case models. The FP model was applied in Guinea, Niger, Togo, and Zambia and the malaria model was applied to investments in Côte d'Ivoire and Tanzania. For each of these six applications, the resulting costs per DALY averted indicated that SBC investments in these health areas are "highly cost-effective". Preliminary results from the breastfeeding/complementary feeding model in Nigeria also indicate "highly cost-effective" findings. SBC advocates can use these business cases to show policy makers the value and power of SBC investments in improving health.

Due to the limited amount of primary source cost data for social and behavior change (SBC) interventions, more research is needed to generate new cost estimates and leverage existing data on SBC costs. The USAID-funded Breakthrough RESEARCH study team combined 161 comparable SBC cost estimates spanning several health areas and containing various combinations of activities, resulting in a wide range of median unit costs. Because of the complexity and variability of these estimates, the team explored using hedonic price estimation techniques to estimate the determinants of SBC intervention costs and developed a tool that can be used for budgeting and program planning purposes. Two separate equations were estimated: 1) SBC for mass media, mid media, and mobile digital interventions where unit costs are "per person exposed" and 2) interpersonal communication (IPC) interventions where unit costs are "per person participated". These results were utilized to create a pricing tool to predict the unit cost of several types of SBC interventions based on the intervention's internal characteristics and external environment.

Given the long-term negative health effects of smoking during adolescence and the substantial role that tobacco-related morbidity and mortality play in the global burden of disease, there is a worldwide need to design and implement effective youth-focused smoking prevention interventions, particularly in Africa where female youth smoking rates are outpacing those of adult women. Smoking prevention interventions focused on both social competence and social influence have been successful in preventing smoking uptake among adolescents in developed countries. However, their effectiveness in developing countries has not yet been clearly demonstrated. Designed and implemented by Good Business together with local media agencies, SKY Girls is a multimedia, empowerment and tobacco prevention program aimed at adolescent girls and young women. The programme is active in five African countries, and uses multiple channels, including in-person events, magazines, movies, radio, and social media to stimulate normative and behavioural change. This presentation discusses an economic evaluation of SKY Girls in Ghana conducted by Tulane University, which found that the programme was effective in improving key intermediate outcomes believed to affect smoking, such as increased social support, decreased pressure to smoke cigarettes and shisha, and improved social norms related to the unacceptability of smoking cigarettes. Translating changes in smoking behaviours into reductions in smoking deaths, SKY Girls was found to be a cost-effective youth smoking prevention intervention, yielding incremental cost-effectiveness ratios of $1,931 / Disability Adjusted Life Year (DALY) averted for the girls sample and $1,298/DALY for all youth.