A school-based cannabis prevention program was cost-effective and potentially cost-saving when targeted to high-risk students
Economic modeling showed Project ALERT was cost-effective for general students and cost-saving when targeted to at-risk boys not engaged in education or work.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- $3.20 return per $1 invested when targeted to at-risk boys
- Evidence Grade:
- Health economic modeling study based on effectiveness data from a prior randomized trial, with assumptions adapted for the Swedish context.
- Study Age:
- Published in 2015. Cannabis policy landscape has shifted significantly since.
- Original Title:
- Cost-Effectiveness of School-Based Prevention of Cannabis Use.
- Published In:
- Applied health economics and health policy, 13(5), 525-42 (2015)
- Authors:
- Deogan, Charlotte, Zarabi, Natalie, Stenström, Nils, Högberg, Pi, Skärstrand, Eva, Manrique-Garcia, Edison, Neovius, Kristian, Månsdotter, Anna
- Database ID:
- RTHC-00944
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Are school drug prevention programs worth the cost?
This economic analysis found that Project ALERT was cost-effective overall and cost-saving when targeted to high-risk students, returning $3.20 for every $1 invested over 20 years in the at-risk subgroup.
Should prevention be targeted to specific students?
The economic case was much stronger when the program was targeted to at-risk boys not engaged in education or work, becoming cost-saving after just 9 years compared to the general population application.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-00944APA
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
MLA
Deogan, Charlotte, et al. "Cost-Effectiveness of School-Based Prevention of Cannabis Use.." Applied health economics and health policy, 2015. https://doi.org/10.1007/s40258-015-0175-4
RethinkTHC
RethinkTHC Research Database. "Cost-Effectiveness of School-Based Prevention of Cannabis Us..." RTHC-00944. Retrieved from https://rethinkthc.com/research/deogan-2015-costeffectiveness-of-schoolbased-prevention
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.