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

Abstract:

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.