Primordial prevention actions should reflect economic impacts and value from a societal perspective. As such, a society with limited resources should determine which interventions have the most value. Cost-effectiveness analysis is the most often used approach for economic evaluation of a medical or health care strategy. In concert with this and a ‘fixed’ monetary allocation for health, policy makers want the greatest return on their investment. For example, studies of smoking cessation intervention suggest that cost per year of saved life is small compared with other interventions. Prevention of death from one disease may not be a valuable outcome if overall life expectancy is not changed because of another significant illness. An obstacle in an investment in prevention is the public expectation that such an investment should pay for itself.