Cost-effectiveness of a school-based tobacco-use prevention program

Objective: To determine the cost-effectiveness of a school-based tobacco-us e prevention program. Design: Using data from the previously reported 2-year efficacy study of th e Project Toward No Tobacco Use (TNT), we conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life ye ars (LYs) saved, quality-adjusted life years (QALYs) saved, and medical car e 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. Intervention: A 10-lesson curriculum designed to counteract social influenc es and misconceptions that lead to tobacco use was delivered by trained hea lth educators to a cohort of 1234 seventh-grade students in 8 junior high s chools. A 2-lesson booster session was delivered to the eighth-grade studen ts 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 $16403, TN T prevented an estimated 34.9 students from becoming established smokers. A s a result, we could expect a saving of $13316 per LY saved and a saving of $8482 per QALY saved. Results showed TNT to be cost saving over a reasonab le range of model parameter estimates. Conclusions: The TNT is highly cost-effective compared with other widely ac cepted prevention interventions. School-based prevention programs of this t ype warrant careful consideration by policy makers and program planners.