A school-based cannabis prevention program was cost-effective and potentially cost-saving when targeted to high-risk students

What the researchers found

Researchers used a Markov model to evaluate the cost-effectiveness of Project ALERT, a school-based substance prevention program, compared to standard drug education. The model tracked students through states of single use, regular use, daily use, and progression to other drugs, accounting for complications like psychosis, depression, and traffic accidents.

Based on US effectiveness data, the program was cost-saving (returning $1.10 for every $1 spent). After adjusting for the Swedish context, it was cost-effective at 22,384 euros per quality-adjusted life-year (QALY), well below the willingness-to-pay threshold of 50,000 euros.

When targeted specifically to at-risk boys (those not in education or work), the program became cost-saving after 9 years (returning $3.20 for every $1 spent after 20 years). This demonstrated that targeted prevention in high-risk groups provides substantially better economic returns.

Why it matters

Governments need economic evidence to justify prevention spending. This study demonstrates that school-based cannabis prevention programs are not just effective but economically rational investments, especially when targeted to high-risk populations.

The numbers in context

Cost-saving at 1:1.1 ratio based on US data. Cost-effective at 22,384 euros/QALY in Swedish context. Targeted to at-risk boys: cost-saving after 9 years, 1:3.2 ratio at 20 years. Willingness-to-pay threshold: 50,000 euros/QALY.

How the study worked

Cost-effectiveness analysis from the societal perspective using a Markov model. Based on Project ALERT effectiveness data, modeling progression through cannabis use states and complications. Follow-up periods from 1 year to lifetime. Costs inflated to 2013 levels with 3% discounting.

What this study cannot tell us

Economic modeling relies on assumptions about state transitions and complication rates. US effectiveness data was adjusted for Sweden, introducing uncertainty. Long-term projections over 20+ years involve substantial modeling assumptions. The effectiveness of Project ALERT specifically has been debated.

How to read the evidence

Health economic modeling study based on effectiveness data from a prior randomized trial, with assumptions adapted for the Swedish context.

When this study was published

Published in 2015. Cannabis policy landscape has shifted significantly since.

The bigger picture

As cannabis legalization expands, the case for investing in evidence-based prevention programs strengthens. This economic analysis shows that such programs can pay for themselves, particularly when focused on the students most at risk of progressing to problematic use.

Questions still open

• Would newer prevention programs show even better cost-effectiveness? How do results change under different legalization regimes? Is targeting high-risk students feasible without stigmatization?

Common questions

Read the original research

Cost-Effectiveness of School-Based Prevention of Cannabis Use.

Applied health economics and health policy, 13(5), 525-42

Citation

Deogan, Charlotte; Zarabi, Natalie; Stenström, Nils; Högberg, Pi; Skärstrand, Eva; Manrique-Garcia, Edison; Neovius, Kristian; Månsdotter, Anna. (2015). Cost-Effectiveness of School-Based Prevention of Cannabis Use.. Applied health economics and health policy, 13(5), 525-42. https://doi.org/10.1007/s40258-015-0175-4

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