Researchers have published the first economic evaluation of a bullying prevention program designed for preschool-aged children, and their exploratory analysis suggests the intervention could deliver meaningful value for money. The Be-Prox program, tested in Norwegian early childhood education and care settings, did not improve its primary outcome in the underlying trial, but it did reduce monthly victimization rates, prompting the team to ask whether those reductions justified the program’s costs.
The analysis was conducted alongside a cluster randomised controlled trial that enrolled 38 early childhood education and care centers, split evenly between 19 intervention sites and 19 control sites, covering 708 children aged 3 to 5 years. The evaluation took a provider and partial municipality perspective, meaning it counted the costs of running the program rather than the full range of societal costs that bullying can impose over a lifetime.
Costs were collected bottom-up through interviews and surveys, and the control group’s costs were assumed to be zero. Running the Be-Prox intervention across the 19 participating centers cost a total of 1,889,031 Norwegian kroner, equivalent to 165,270 euros.
To judge whether that spending was worthwhile, the researchers calculated an incremental cost-effectiveness ratio using the unweighted mean difference between the two arms in the proportion of children spared from negative acts at follow-up. On that basis, the primary estimate came to 41,336 Norwegian kroner, or 3,616 euros, per child saved, derived from a mean difference of 12.9 percentage points between the arms, corresponding to 45.7 children saved.
A secondary, exploratory estimate built on an adjusted odds ratio of 0.40 reported in the trial’s effect paper produced a lower figure of 26,330 Norwegian kroner, or 2,304 euros, per child saved, corresponding to 71.7 children saved. The two approaches rest on different statistical assumptions, and the authors describe the analysis as exploratory throughout.
Because any single cost-effectiveness estimate carries uncertainty, the team tested how sensitive the result was to changes in the cost assumptions. When intervention costs were varied by plus or minus one standard deviation, the primary ratio ranged from 16,734 to 65,936 Norwegian kroner, or 1,464 to 5,770 euros, per child saved, staying within a similar order of magnitude. Varying costs by plus or minus one standard error of the mean produced a narrower range of 35,691 to 46,980 Norwegian kroner, or 3,123 to 4,110 euros.
The researchers also ran a deterministic sensitivity analysis in which 10 to 30 percent of the intervention costs were assigned to the control group instead of assuming zero control costs. Under that nonzero assumption, the ratio fell to between 28,931 and 37,206 Norwegian kroner, or 2,531 to 3,255 euros, per child saved.
Uncertainty was further assessed using bootstrap resampling at the level of the early childhood education and care centers, summarized through cost-effectiveness planes and acceptability curves. The probabilistic analysis showed that 97.3 percent of bootstrap draws fell in the north-east quadrant of the cost-effectiveness plane, meaning the intervention was both more costly and more effective in those draws. The cost-effectiveness acceptability curve indicated a 50 percent probability of cost-effectiveness at the primary threshold, rising to 88 percent at 100,000 Norwegian kroner, or 8,749 euros, per child saved.
The authors conclude that the Be-Prox intervention has the potential to be cost-effective. While the findings are exploratory, they represent the first economic evidence for bullying prevention at the early childhood education and care level and may inform early preventive strategies. The team notes that future research should adopt broader societal perspectives and longer follow-up periods to capture downstream cost savings that a provider-level analysis cannot see.
The trial behind the analysis was registered at ClinicalTrials with the identifier NCT06040437 on 2 September 2023. The study was published open access in the journal Cost Effectiveness and Resource Allocation on 20 October 2026, and the published version is subject to further editorial edits as an early-release, peer-reviewed article.
Subject of Research: An exploratory economic evaluation of the Be-Prox anti-bullying intervention in Norwegian early childhood education and care settings.
Article Title: Economic evaluation of the Be-Prox anti-bullying intervention in Norwegian early childhood education and care settings: an exploratory partial within-trial cost-effectiveness analysis alongside a cluster randomised controlled trial
Article References: Angeles, R. C., Kvestad, I., Aasheim, M., Breivik, K., Mabille, G., Kyrrestad, H., & Kjerstad, E. (2026). Economic evaluation of the Be-Prox anti-bullying intervention in Norwegian early childhood education and care settings: an exploratory partial within-trial cost-effectiveness analysis alongside a cluster randomised controlled trial. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00854-6
Image Credits: AI Generated
DOI: 10.1186/s12962-026-00854-6
Keywords: bullying prevention, cost-effectiveness, early childhood education, cluster randomised controlled trial, Norway, Be-Prox, economic evaluation, ICER, peer victimization, preschool children, Economic, evaluation
News Source: Courtney Benton. (October 29, 2026). Anti-bullying program in Norwegian preschools shows potential cost-effectiveness in trial analysis. Scienmag.
