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Cost-Effectiveness Analysis of the Not On Tobacco Program for Adolescent Smoking Cessation

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Abstract

Public health researchers and practitioners emphasize the need for effective, adoptable, and available youth smoking cessation interventions. Scarce resources demand that such interventions also be cost effective. This study describes a cost-effectiveness analysis (CEA) of the American Lung Association’s Not On Tobacco (N-O-T) national and international teen smoking cessation program. N-O-T has been rigorously evaluated as an effective and adoptable program, and was recently found to be the most frequently-used teen smoking cessation program in the nation. N-O-T studies show intent-to-treat quit rates between 15% and 19%, among the highest reported in the literature. The current CEA resulted from a 2-year state-wide demonstration study in Florida, comparing the effectiveness of N-O-T with a 20-min brief intervention (BI). The CEA utilized a Markov transition model of decision analysis to explain stage progression of smoking cessation among participants from the age of 17 to 25 years. The Markov simulation predicted that out of a cohort of 100 N-O-T students, 10 will quit smoking and remain smoke-free at the age of 25 years and 14 will reduce smoking, resulting in 102.22 life years saved and a total of 20.11 years discounted life years (DLY) saved. Among BI youth, six will quit smoking and nine will reduce, indicating 64.31 life years saved and a total 12.65 DLY saved. The incremental DLY saved is 7.46 years. Results indicate that N-O-T is a very cost-effective option school-based smoking cessation, as cost effective as school-based primary tobacco prevention, and potentially more cost effective than adult tobacco use cessation.

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Notes

  1. Despite the controversies associated with discounting life years, we believe that failure to do so results in bias results in favor of non-discounted cost-effectiveness ratios.

  2. We are grateful to a workshop participant at the 16th National Chronic Disease Conference in Atlanta, GA, for making this illustration.

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Acknowledgments

Funding for the Not On Tobacco efficacy studies described in this manuscript was provided by The Florida Department of Health, Office of Tobacco Control. Funding for this cost-effectiveness analysis was provided by the Centers for Disease Control and Prevention’s Cooperative Agreement with the WV Prevention Research Center (U48/CCU310821). The contents of the paper are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

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Dino, G., Horn, K., Abdulkadri, A. et al. Cost-Effectiveness Analysis of the Not On Tobacco Program for Adolescent Smoking Cessation. Prev Sci 9, 38–46 (2008). https://doi.org/10.1007/s11121-008-0082-0

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