Economic evaluations of substance abuse prevention programs for youth ages 8-18: A systematic review

Gitanjali Shrestha

Goal: The goal of the current study is to conduct a systematic review of peer-reviewed economic evaluations of substance abuse prevention programs aimed at youth between the ages of 8 and 18. Method: I assessed the reporting quality of economic evaluations along with the methodological quality of intervention articles on which the economic evaluations were based. I included randomized controlled trials, quasi-experimental studies, and non-experimental studies that quantitatively measured outcomes of interest. In addition to searching eight databases, I searched the reference lists of economic evaluations and intervention articles to identify peerreviewed economic evaluations of youth substance abuse prevention programs. I also used "cited by" Google feature to identify additional economic evaluations. Results: Altogether, I included eight economic evaluations and their corresponding intervention articles in the current review. These eight economic evaluations assessed nine prevention programs. All prevention programs were universal in nature. Almost all programs targeted some form of tobacco use. Most of the programs were implemented in USA. The methodological quality of intervention articles and reporting quality of economic evaluations varied widely. Most intervention articles either did not test for baseline equivalence or did not control for baseline differences in their analyses. Most articles either did not report attrition rate or had high attrition rates (more than 20%). Almost none of the articles reported power analysis. Reporting quality of economic evaluations varied widely. The most popular technique for conducting an economic evaluation was cost-effectiveness analysis, followed by cost-utility analysis, and benefit-cost analysis. Most economic evaluations reported a discount rate; however, none of the evaluations with multiyear intervention discounted costs incurred after first year of intervention. Almost all economic evaluations reported results of sensitivity analyses with most of them addressing parameter uncertainty but not methodological uncertainty. Most economic evaluations did not address generalizability of their findings. Conclusion: We need to devote more resources for economic evaluations of substance abuse prevention programs for youth. Given that most of the economic evaluations included in the current review focused on tobacco, future studies should place more emphasis on outcomes related to alcohol and other substances.

Economic evaluations of substance abuse prevention programs for youth ages 8-18: A systematic review

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