Life Years Saved, Quality-Adjusted Life Years Saved and Cost-Effectiveness of a School-Based Tobacco Prevention Program

  • L. Y. Wang
  • C. Linda
  • R. Lowry
  • G. Tao
Reference work entry


Project Toward No Tobacco Use (TNT) is a school-based education curriculum designed to prevent tobacco use among junior and senior high school students. An efficacy evaluation of Project TNT showed that a combined-strategy curriculum was effective in reducing both trial and weekly cigarette use. During the 2 years, trial cigarette use among intervention students increased from 37 to 53%, and weekly use increased from 6 to 10%. Among control students, trial cigarette use increased from 35 to 58%, and weekly cigarette use increased from 4 to 13%. On the basis of these findings, we conducted an economic evaluation to determine the cost-effectiveness of Project TNT. The benefits measured were life years (LYs) saved,  quality-adjusted life years (QALYs) saved, and medical care costs saved under a 3% discount rate. The costs measured were the costs of Project TNT program. We quantified TNT’s cost-effectiveness as cost per LY saved and cost per QALY saved. Under base case assumptions, at an intervention cost of $16,403, Project TNT prevented an estimated 34.9 students from becoming  established smokers. As a result, we estimated a cost savings of $10,733 accompanying every LY saved and a cost savings of $7,667 accompanying every QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates. Project 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.


National Health Interview Survey Smokeless Tobacco Medical Care Cost HRQL Score Senior High School Student 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


Centers for Disease Control and Prevention


health-related quality of life


Institute of Medicine


life years

Project TNT

Project Toward no Tobacco Use


quality-adjusted life years


Substance Abuse and Mental Health Services Administration


  1. Botvin GJ, Baker E, Dusenbury L, Botvin EM, Diaz T. (1995). JAMA. 273: 1106–1112.PubMedCrossRefGoogle Scholar
  2. CDC. (1989). Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General. Washington, DC.Google Scholar
  3. CDC. (1990). Interview Survey Part I (Public Use Data Tape Documentation). Hyattsville, MD.Google Scholar
  4. CDC. (1994a). Preventing Tobacco Use Among Young People: A Report of the US Surgeon General. Atlanta, GA, pp. 209–292.Google Scholar
  5. CDC. (1994b). Morb Mortal Wkly Rep. 43: 1–18.Google Scholar
  6. CDC. (1995). Stat Notes. 7: 1–14.Google Scholar
  7. CDC. (2000). Reducing Tobacco Use: A Report of the Surgeon General. Washington, DC.Google Scholar
  8. CDC. (2005). Morb Mortal Wkly Rep. 54: 625–628.Google Scholar
  9. CDC. (2007). Best Practices for Comprehensive Tobacco Control Programs. Washington, DC.Google Scholar
  10. Cummings SR, Rubin SM, Oster G. (1989). JAMA. 261: 75–79.PubMedCrossRefGoogle Scholar
  11. Dent CW, Sussman S, Stacy AW, Craig S, Burton D, Flay BR. (1995). J Consult Clin Psychol. 63: 676–677.PubMedCrossRefGoogle Scholar
  12. Dobbins M, DeCorby K, Manske S, and Goldblatt E. (2008). Prev Med. 46: 289–297.PubMedCrossRefGoogle Scholar
  13. Flay BR, Koepke D, Thomson SJ, Santi S, Best JA, Browns KS. (1989). Am J Public Health. 79: 1371–1376.PubMedCrossRefGoogle Scholar
  14. Gold MR, Siegel JE, Russell LB, Weinstein MC. (1996). Cost-effectiveness in health and medicine. Oxford University Press, New York, NY.Google Scholar
  15. Hodgson TA. (1992). Milbank Q. 70: 81–125.PubMedCrossRefGoogle Scholar
  16. IOM. (2007) Ending the Tobacco Problem: A Blue-Print for the Nation. Washington, DC (Appendix D17).Google Scholar
  17. Manning WG, Keeler EB, Newhouse JP, Sloss EM, Wasserman J. (1989). JAMA. 261: 1604–1609.PubMedCrossRefGoogle Scholar
  18. Oster G, Huse DM, Delea TE, Colditz GA. (1986). JAMA. 256: 1315–1318.PubMedCrossRefGoogle Scholar
  19. Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. (1996). Health Psychol. 15: 355–361.PubMedCrossRefGoogle Scholar
  20. Rogers RG, Powell-Griner E. (1991). Soc Sci Med. 32: 1151–1159.PubMedCrossRefGoogle Scholar
  21. SAMHSA. (2005) Results from the 2005 National Survey on Drug Use and Health. Rockville, MD.Google Scholar
  22. SAMHSA. (2007) Office of Applied Studies, National Survey on Drug Use and Health, 2005 and 2006 (Table 4.5B–4.8B).Google Scholar
  23. Sussman S. (2001). Am J Health Behav. 25: 191–199.PubMedGoogle Scholar
  24. Sussman S, Dent CW, Burton D, Stacy AW, Flay BR. (1995). Developing School-Based Tobacco Use Prevention and Cessation Programs. Sage, Thousand Oaks, CA.Google Scholar
  25. Wang LY, Haddix AC, Teutsch SM, Caldwell B. (1999). Am J Manag Care. 5: 445–454.PubMedGoogle Scholar
  26. Wang LY, Crossett LS, Lowry R, Sussman S, Dent CW. (2001). Arch Pediatr Adolesc Med. 155: 1043–1050.PubMedGoogle Scholar
  27. Wasley MA, McNagny SE, Phillips VL, Ahluwalla JS. (1997). Prev Med. 26: 264–270.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • L. Y. Wang
  • C. Linda
  • R. Lowry
  • G. Tao

There are no affiliations available

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