Purpose : The purpose of this paper is to discuss the economic pressures on long-term care systems, and describe how an economic case might be made for better care, support and preventive strategies. Design/methodology/approach: Discussion of recent developments and research responses, with illustrations from previous studies. Findings: Economics evidence is highly relevant to decision makers in health, social care, and related systems. When resources are especially tight, economics evidence can sometimes persuade uncertain commissioners and others to adopt courses of action that improve the wellbeing of individuals, families, and communities. Originality/value: The paper uses long-established approaches in economic evaluation to discuss preventive and other strategies in today's challenging context.