Cost-effectiveness of a school-based tobacco-use prevention program.
OBJECTIVE
To determine the cost-effectiveness of a school-based tobacco-use prevention program.


METHODS
Using data from the previously reported 2-year efficacy study of the Project Toward No Tobacco Use (TNT), we conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life years (LYs) saved, quality-adjusted life years (QALYs) saved, and medical care costs saved, discounted at 3%. The costs measured were program costs. We quantified TNT's cost-effectiveness as cost per LY saved and cost per QALY saved.


METHODS
A 10-lesson curriculum designed to counteract social influences and misconceptions that lead to tobacco use was delivered by trained health educators to a cohort of 1234 seventh-grade students in 8 junior high schools. A 2-lesson booster session was delivered to the eighth-grade students in the second year. The efficacy evaluation was based on 770 ninth-grade students who participated in the program in the seventh and eighth grades and in both the baseline and the 2-year follow-up survey.


RESULTS
Under base case assumptions, at an intervention cost of $16 403, TNT prevented an estimated 34.9 students from becoming established smokers. As a result, we could expect a saving of $13 316 per LY saved and a saving of $8482 per QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates.


CONCLUSIONS
The TNT is highly cost-effective compared with other widely accepted prevention interventions. School-based prevention programs of this type warrant careful consideration by policy makers and program planners.
Wang
L Y
LY
Surveillance and Evaluation Research Branch, Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. lgw0@cdc.gov
Crossett
L S
LS
Lowry
R
R
Sussman
S
S
Dent
C W
CW
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003362:Cost-Benefit Analysis; D003479:Curriculum; D005260:Female; D006266:Health Education / Q000191:economics*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000009:adverse effects / Q000191:economics; D000074606:Smoking Prevention