How much does an extra year of life cost? $443 is the price according to a team of researchers and economists led by Geri Dino at the Prevention Research Center at West Virginia University.

This figure has emerged from a cost-effectiveness analysis of the American Lung Association’s Not On Tobacco (N-O-T) teen smoking cessation program.

Increasingly, policy makers know what works. Evidence from rigorous evaluations points to a range of promising or proven prevention, early intervention or treatment programs. But decision makers are still left asking, “Is it worth it?”.

Geri Dino and her colleagues reviewed the evidence: half of all young people have tried cigarettes and 25 per cent of high school children say they are regular smokers. Worse, of those who smoke, it is known that one third will die of a smoking-related disease. This all adds up to the stark conclusion that smoking may contribute to the death of one in twelve children.

Considering these sobering figures it’s not surprising to find a wealth of public health, prevention and treatment approaches aiming to stop young people taking up smoking or trying to help the smokers quit. But with so many programs to choose from – and a growing number able to point to successful randomized controlled trials to support their claims – how are policy makers with limited resources to make the right choice?

Hence Dino and her team's argument in favor of cost-effectiveness analysis, and their demonstration if its application to the N-O-T program, the most widely used of its kind in the US. It comprises ten gender-specific sessions, usually delivered in schools by trained facilitators. Quasi-experimental evaluations demonstrate quit rates of between 15% and 19%.

At the heart of cost-effectiveness analysis are predictive statistics called “Markov Transition Models”, which put a price on program benefits. So one may have a big impact on child outcomes, but the “roll-out” cost may be impractically high. Or the benefits of another may be pretty modest, but because the program is so cheap it may well worth the investment.

For 100 young people receiving the N-O-T program, the cost turns out to be around $3400, compared to a mere $60 for more typical school approaches.

But the greater investment pays dividends. For the 100 young people enrolled in N-O-T, ten will quit and 14 cut back (compared to six quitting and nine cutting back in the case of more typical school approaches). Based on these figures and the elaborate predictive models, a moderate estimate is that for the 100 children receiving N-O-T, 102 years of life will be saved, compared to 64 years for standard school approaches.

The cost of a year of life is deduced from these estimates: based on the cost of the program and the predicted benefits, each year of life saved is worth $443 – approximately the amount a young person would spend on cigarettes in a year.

Ultimately it remains a policy maker’s judgment call. The real utility of the approach will be brought into sharper focus as more evaluations consider cost-effectiveness, allowing comparisons between many proven programs.