Do school-based tobacco prevention programmes pay off? The cost-effectiveness of the 'smoke-free class competition'

Objective: The objective of this study was to determine the cost-effectiveness of a school-based tobacco prevention programme. Study design: Using data from a previous effectiveness study of the 'Smoke-free Class Competition' (SFC), an economic analysis was conducted to determine the cost-effectiveness of the SFC. Cost data were collected from financial statements of the operating agency, surveys of regional co-ordinators and participating classes (direct and productivity costs). The benefit was the product of the number of students prevented from becoming established smokers, based on a stochastic progression model extending the programme's outcome evaluation, and the (direct and indirect) value per prevented smoker. Intervention: To take part in the SFC, classes make the decision to be a non-smoking class for 6 months (from autumn to spring). The pupils themselves and their teachers monitor the smoking status of the pupils and report on it regularly. Classes that refrain from smoking can win a number of attractive prizes. In the school year 2001/2002 150,566 German students participated in the SFC, representing approximately 4% of the total target population of 11-14-year-old German students. The effectiveness evaluation is based on 2,142 students who participated in the programme in the school year 1998/1999. Results: In the school year 2001/2002, it is estimated that the SFC prevented 3,076 students from becoming established smokers, with net benefits of 5.59 Mio. Euro (direct net benefits) and 15.00 Mio. Euro, (total net benefits). The direct benefit/cost ratio was 8.2 and the total benefit/cost ratio was 3.6. Conclusions: Data suggest that the SFC is a cost-effective school-based intervention. (c) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.