The Cost-Effectiveness of Intensive National School-Based Anti-Tobacco Education: Results from the Tobacco Policy Model
ABSTRACT School-based anti-tobacco education using the "social influences" model is known to reduce smoking among youth by 5-56%. Program effectiveness, however, dissipates in 1-4 years. Consequently, opinion leaders have questioned whether a more intensive national educational effort would be economically efficient. To address this question, we evaluated the cost-effectiveness of enhanced nationwide school-based anti-tobacco education relative to the status quo.
To estimate cost-effectiveness, we created the Tobacco Policy Model, a system dynamics computer simulation model. The model relies on secondary data and is designed to calculate the expected costs and public health gains of any tobacco policy or intervention over any time frame.
Over 50 years, cost-effectiveness is estimated to lie between $4,900 and $340,000 per quality-adjusted life-year (QALY), depending on the degree and longevity of program effectiveness. Assuming a 30% effectiveness that dissipates in 4 years, cost-effectiveness is $20,000/QALY. Sensitivity analysis reveals that cost-effectiveness varies with cost, survival, and quality-of-life estimates but cost-effectiveness ratios generally remain favorable.
Although not cost saving, a much more intensive school-based anti-tobacco educational effort would be an economically efficient investment for the nation.
- SourceAvailable from: Elizabeth M Ginexi
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- "Changes in return on investment over time and " tipping points " could also be investigated. Finally, in addition to simulating the impacts on prevention outcomes, such models could also help quantify the delays, costs, and logistic challenges associated with training and other aspects of going to scale (see Tengs et al. 2001). Systems science approaches may help identify aspects of real world systems that we do not fully understand but that impact on intervention decision-making. "
ABSTRACT: The problems targeted by preventive interventions are often complex, embedded in multiple levels of social and environmental context, and span the developmental lifespan. Despite this appreciation for multiple levels and systems of influence, prevention science has yet to apply analytic approaches that can satisfactorily address the complexities with which it is faced. In this article, we introduce a systems science approach to problem solving and methods especially equipped to handle complex relationships and their evolution over time. Progress in prevention science may be significantly enhanced by applying approaches that can examine a wide array of complex systems interactions among biology, behavior, and environment that jointly yield unique combinations of developmental risk and protective factors and outcomes. To illustrate the potential utility of a systems science approach, we present examples of current prevention research challenges, and propose how to complement traditional methods and augment research objectives by applying systems science methodologies.Prevention Science 09/2012; 14(3). DOI:10.1007/s11121-012-0285-2 · 2.63 Impact Factor
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- "The system dynamics literature has broadly been classified into two groups: those that deal with specific diseases and those that deal with broader policy and management concerns. Literature focusing on diseases includes: Oral Health (Hirsch et al., 1975); Cardiovascular Disease (Hirsch and Myers,1975 & Luginbuhl et al., 1981); Diabetes (Homer et al., 2004 & Jones et al., 2006); Obesity (Homer et al., 2006); smoking (Tengs et al., 2001); and chronic illnesses more generally (Hirsch and Immediato, 1999 and Homer et al., 2007). Literature focusing on management includes: EHIR Adoption (Erdil & Emerson, 2008); Ward Management (Akiyama et al, 2008, 2009); Telecare (Bayer et al, 2007); Patient flow (Wolstenholme, 1999); Safe Design Capacity (Wolstenholme et al, 2007); and Waiting Lists (Van Ackere and Smith 1999). "
ABSTRACT: To better understand the performance of hospital operations in response to IT-enabled improvement, this paper reports the results of a system dynamics model designed to improve core medical processes. Utilizing system dynamics modeling and emerging Health Information Systems HIS data, the authors demonstrate how current behavior within the hospital leads to a 'stove-pipe' effect, in which each functional group employs policies that are rational at the group level, but that lead to inefficiencies at the hospital level. The authors recommend management improvements in both materials and staff utilization to address the stove-pipe effect, estimate the resultant cost-saving, and report the results of an experiment conducted in the hospital to validate the approach. Results indicate that the major gains in health information systems use will accompany new information gathering capabilities, as these capabilities result in collections of data that can be used to greatly improve patient safety, hospital operations, and medical decision support.International Journal of Information Technologies and Systems Approach 01/2012; 5:19-36. DOI:10.4018/jitsa.2012010102
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- "Another group estimated the costs of Project TNT at $US48 per student and that TNT would cost about $US20,000 per quality-adjusted life-year (QALY) gained . While not cost saving, they concluded that smoking prevention offers gains in both survival and health-related quality of life that make it worth the cost. "
ABSTRACT: I provide a systematic review of trials of school-based smoking prevention programs that had at least 15 sessions, preferably with some in high school, that reported significant short-term effects, and that included long-term follow-up. This is supplemented with a description of some other programs that produce short-term effects that portend large long-term effects. I conclude that school-based programs can have long-term effects of practical importance it they: include 15 or more sessions over multiple years, including some in high school; use the social influence model and interactive delivery methods; include components on norms, commitment not to use, intentions not to use, and training and practice in the use of refusal and other life skills; and use peer leaders in some role. School-based programs of this type can reduce smoking onset by 25-30%, and school plus community programs can reduce smoking onset by 35-40% by the end of high school. Some early childhood programs that do not have smoking prevention as their main aim, including home nursing, the Good Behavior Game, the Positive Action program and others, seem to change the developmental trajectories of children so that they are less likely to engage in multiple problem behaviors, including smoking, as adolescents. This review makes it clear that effective school-based smoking prevention programs exist and can be adopted, adapted and deployed with success - and should be.Tobacco Induced Diseases 04/2009; 5(1):6. DOI:10.1186/1617-9625-5-6 · 1.50 Impact Factor