Skip to main content
SpringerLink
Log in

Cost-Effectiveness of School-Based Prevention of Cannabis Use

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school.

Methods

The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3 %, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the ‘states’ of single use, regular use, daily use and use of other illicit drugs, which were associated with ‘complications’ of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications.

Results

The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years.

Conclusion

School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated here.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. United Nations Office on Drugs and Crime (UNODC). World drug report 2012. United Nations: Vienna. 2012. http://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf. Accessed 23 Sep 2014.

  2. Public Health Agency of Sweden (PHAS) [Folkhälsomyndigheten]. National public health survey [Hälsa på Lika Villkor]. 2013. http://www.folkhalsomyndigheten.se/documents/statistik-uppfoljning/enkater-undersokningar/nationella-folkhalsoenkaten/Resultat-2013/resultat-cannabis-hlv-2013.xls. Accessed 23 Sep 2014.

  3. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Prevalence of daily use of cannabis in the European Union and Norway. 2013. http://www.emcdda.europa.eu/attachements.cfm/att_191926_EN_emcdda-daily-cannabis-use-2012.pdf. Accessed 23 Sep 2014.

  4. Swedish National Institute of Public Health. Adverse health consequences of cannabis use: a survey of scientific studies published up to and including 2008. 2010. https://www.folkhalsomyndigheten.se/pagefiles/12459/R2010-19-Adverse-Health-Consequences-Cannabis-Use-.pdf. Accessed 17 March 2015.

  5. Project ALERT. 2015. http://www.ProjectALERT.com.

  6. National Board of Health and Welfare [Socialstyrelsen]. Kostnader för alkohol och narkotika. Beräkningar av samhällets direkta kostnader 2003. 2010. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/17961/2010-3-15.pdf. Accessed 30 Dec 2014.

  7. Assessing Health Care Intervention [Kunskapscentrum för hälso- och sjuvården (SBU)]. Utvärdering av metoder i hälso- och sjukvården—en handbok. Version 2010:1. 2010. http://sbu.se/upload/ebm/metodbok/SBUsHandbok_Kapitel11.pdf. Accessed 23 Sep 2014.

  8. Statistics Sweden. Prisomräknaren—räkna på inflationen. 2013. http://www.scb.se/sv_/Hitta-statistik/Statistik-efter-amne/Priser-och-konsumtion/Konsumentprisindex/Konsumentprisindex-KPI/33777/Prisomraknaren–rakna-pa-inflationen/. Accessed 17 March 2015.

  9. The Riksbank. Årsgenomsnitt valutakurser (ackumulerat). 2014. http://www.riksbank.se/sv/Rantor-och-valutakurser/Arsgenomsnitt-valutakurser/. Accessed 17 March 2017.

  10. Ellickson PL, McCaffrey DF, Ghosh-Dastidar B, Longshore DL. New inroads in preventing adolescent drug use: results from a large-scale trial of Project ALERT in middle schools. Am J Public Health. 2003;93(11):1830–6.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Karlberg M, Sundell K. SKOLK Sund protest eller riskbeteende? FoU-rapport 2004:1. Socialtjänstförvaltningen; 2004.

  12. Skärstrand E. Prevention of alcohol and drug problems among adolescents: evaluating a Swedish version of the Strengthening Families Program. Karolinska Institutet. Printed by Universitetsservice AB; 2010.

  13. Skärstrand E, Sundell K, Andréasson S. Evaluation of a Swedish version of the Strengthening Families Programme. Eur J Public Health. 2013;24(4):578–84.

    Article  PubMed  Google Scholar 

  14. National Agency for Education. Kostnader–Riksnivå 2013. Sveriges officiella statistik om förskola, skola och vuxenutbildning. Del 3, 2013. http://www.skolverket.se/om-skolverket/publikationer/visa-enskild-publikation?_xurl_=http%3A%2F%2Fwww5.skolverket.se%2Fwtpub%2Fws%2Fskolbok%2Fwpubext%2Ftrycksak%2FRecord%3Fk%3D3082. Accessed 17 March 2015.

  15. Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for economic evaluation of health care programmes (third edition). Corby Northants: Oxford University Press; 2005.

    Google Scholar 

  16. Statistics Sweden. Genomsnittlig grund- och månadslön samt kvinnors lön i procent av mäns lön efter region, sektor, yrke (SSYK) och kön. År 2005–2013. 2013. http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__AM__AM0110__AM0110A/LonYrkeRegion4/?rxid=977b1fff-e46a-4b43-8ca6-200c94b053fd. Accessed 17 March 2015.

  17. The Swedish Tax Agency. [Skattemyndigheten] Arbetsgivaravgifter. 2013. http://www.skatteverket.se/foretagorganisationer/arbetsgivare/socialavgifter/arbetsgivaravgifter.4.233f91f71260075abe8800020817.html. Accessed 17 March 2015.

  18. Jowett S, Bryan S, Mahé I, Brieger D, Carlsson J, Kartman B, Nevinson M. A multinational investigation of time and traveling costs in attending anticoagulation clinics. Value Health. 2008;11(2):207–12.

    Article  PubMed  Google Scholar 

  19. Printing.info. [Tryckerier.Info]. 2015. http://tryckerier.info/vad-kostar-det-att-trycka/kostnad-for-att-trycka-broschyrer-och-foldrar. Accessed 17 March 2015.

  20. Bretteville-Jensen AL, Jacobi L. Hard drug uptake among cannabis users: a Bayesian analysis. Norwegian Institute for Alcohol and Drug Research (SIRUS); Department of Economics, University of Melbourne. 2007. http://yoda.eco.auckland.ac.nz/nzesg/PDFs/paper/Jacobi.pdf. Accessed 23 Sep 2014.

  21. Chabrol H, Fredaigue S, Callahan S. Etude épidémiologique de l´abus et del la dépendance au cannabis parmi 256 adolescents. L´Encéphale. 2000;XXVI:47–49.

  22. Public Health Agency of Sweden (PHAS) [Folkhälsomyndigheten]. Skador av hasch och marijuana: en genomgång av vetenskapligs studier publicerade till och med 2008. 2009. http://www.fhi.se/PageFiles/7915/R-2009-13-Skador-av-hasch-o-marijuana.pdf. Accessed 23 Sep 2014.

  23. National Police Board [Rikspolisstyrelsen]. Polisens arbete mot narkotika. 2011:1. 2011. http://www.polisen.se/Global/www%20och%20Intrapolis/Rapporter-utredningar/01%20Polisen%20nationellt/Narkotika/Pol_arb_m_Narkotikarapport_inl110825w.pdf. Accessed 23 Sep 2014.

  24. Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P. Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort. Psychol Med. 2012;42(6):1321–82011.

    Article  CAS  PubMed  Google Scholar 

  25. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):e141.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383–91.

    Article  CAS  PubMed  Google Scholar 

  27. Gerberich SG, Sidney S, Braun BL, Tekawa IS, Tolan KK, Quesenberry CP. Marijuana use and injury events resulting in hospitalization. Ann Epidemiol. 2003;13:203–37.

    Article  Google Scholar 

  28. Swedish Transport Administration [Trafikverket]. Antalet döda i vägtrafiken det lägsta på nästan 100 år—Sverige klarar EUs halveringsmål; 2011.

  29. Solowij N, Lemon J. The health and psychological consequences of cannabis use. Prepared for the National Task Force on Cannabis. Monograph Series No. 25. 1994. http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubs-drug-cannab2-ch1.htm. Accessed 23 Sep 2014.

  30. Psychology Guide [Psykologiguiden]. 2014. http://www.psykologiguiden.se/www/pages/?Lookup=depression. Accessed 23 Sep 2014.

  31. Lynskey M, Hall W. The effects of adolescent cannabis use on educational attainment: a review. Addiction. 2000;95(11):1621–30.

    Article  CAS  PubMed  Google Scholar 

  32. Burström K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res. 2001;10:621–35.

    Article  PubMed  Google Scholar 

  33. Degenhardt L, Ferrari AJ, Calabria B, Hall WD, Norman RE, McGrath J, Flaxman AD, Engell RE, Freedman GD, Whiteford HA, Vos T. The global epidemiology and contribution of cannabis use and dependence to the global burden of disease: results from the GBD 2010 Study. PLoS One. 2013. doi:10.1371/journal.pone.0076635

    Google Scholar 

  34. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003. Australian Institute of Health and Welfare. 2007. http://www.who.int/publications/cra/chapters/volume1/1109-1176.pdf. Accessed 23 Sep 2014.

  35. Dijkgraaf M, van der Zanden B, de Borgie C, Blanken P, van Ree J, van den Brink W. Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials. BMJ. 2005;330:1297–300.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Briggs A, Wild D, Lees M, Reaney M, Dursun S, Parry D, Mukherjee J. Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes. 2008;6:105.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Lenert LA, Sturley AP, Rapaport MH, et al. Public preferences for health states with schizophrenia and a mapping function to estimate utilities from positive and negative symptom scale scores. Schiz Res. 2004;71:155–75.

    Article  Google Scholar 

  38. Revicki DA, Shakespeare A, Kind P. Preferences for schizophrenia-related health states: a comparison of patients, caregivers and psychiatrists. Int Clin Psychopharmacol. 2006;11:101–8.

    Google Scholar 

  39. Einarson TR, Pudas H, Zilbershtein R, Jensen R, Vicente C, Piwko C, Hemels ME. Cost-effectiveness analysis of atypical long-acting antipsychotics for treating chronic schizophrenia in Finland. J Med Econ. 2013;16(9):1096–105.

    Article  PubMed  Google Scholar 

  40. Burström K, Sun S, Gerdtham UG, Henriksson M, Johannesson M, Levin LÅ, Zethraeus N. Swedish experience-based value sets for EQ-5D health states. Qual Life Res. 2014;23(2):431–42.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Statistics Sweden. Dödstal per 1000 av medelfolkmängden efter ålder och kön. År 2000–2013. 2013. http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101I/Dodstal/?rxid=aee57cff-b16d-4a4e-afe1-91ae66517feb. Accessed 17 March 2015.

  42. Davstad I, Allebeck P, Leifman A, Stenbacka M, Romelsjö A. Self-reported drug use and mortality among nationwide sample of Swedish conscripts—a 35-year follow-up. Drug Alcohol Depend. 2011;118(211):383–90.

    Article  PubMed  Google Scholar 

  43. Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia. Arch Gen Psychiatry. 2007;64(10):1123–1131.

    Article  PubMed  Google Scholar 

  44. Soole DW, Mazerolle L, Rombouts S. School-based drug prevention programs: a review of what works. Austr N Z J Criminol. 2008;41(2):259–86.

    Article  Google Scholar 

  45. Flay BR, Graumlich S, Segawa E, Burns JL, Holliday MY. Effects of 2 preventions programs on high-risk behaviors among African American youth. Arch Pediatr Adolesc Med. 2004;158:377–84.

    Article  PubMed Central  PubMed  Google Scholar 

  46. St Pierre TL, Osgood DW, Mincemoyer CC, Kaltreider DL, Kauh TJ. Results of an independent evaluation of Project ALERT delivered in schools by cooperative extension. Prev Sci. 2005;6(4):305–17.

    Article  PubMed  Google Scholar 

  47. Kovach Clark H, Shamblen SR, Hanley AM, Flewelling RL. Are substance prevention programs more effective in schools making adequate yearly progress? A study of Project ALERT. J Drug Educ. 2011;41(3):271–88.

    Article  Google Scholar 

  48. Mogyorosy Z, Smith P. Centre of Health Economics, The University of York. The main methodological issues in costing health care services: a literature review. CHE Research Paper 7. 2005. http://www.york.ac.uk/che/pdf/rp7.pdf. Accessed 23 Sep 2014.

  49. Cooper N, Coyle D, Abrams K, Mugford M, Sutton A. Potential hierarchies of data sources for economic evaluation (modified from Coyle and Lee). J Health Serv Res Policy. 2005;10:245. http://hsr.sagepub.com/content/10/4/245. Accessed 23 Sep 2014.

  50. Swedish Association of Local Authorities and Regions [SKL]. Kostnad per patient, KPP. 2013. http://skl.se/ekonomijuridikstatistik/statistiknyckeltaljamforelser/kostnadperpatientkpp.1076.html. Accessed 17 March 2015.

  51. Central Council for Information on Alcohol and Other Drugs (CAN) [Centralförbundet för alkohol- och narkotikaupplysning]. Drogutvecklingen i Sverige. Rapport 130. 2011. http://www.can.se/PageFiles/1299/drogutvecklingen-i-sverige-2011.pdf?epslanguage=sv. Accessed 23 Sep 2014.

  52. Guttormsson U. Narkotikatillgängligheten I Sverige 1988-2011. Rapport 132. 2011. http://www.can.se/PageFiles/3534/CAN-Rapportserie-132-Narkotikatillg%c3%a4ngligheten%201988-2011.pdf?epslanguage=sv. Accessed 23 Sep 2014.

  53. Statistics Sweden. Kostnad för kommunernas individ- och familjeomsorg. År 2008–2013. 2013. http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__OE__OE0107__OE0107B/IndFamTkrR/?rxid=415ca105-0197-4b42-a3fa-ccc779532ee6. Accessed 17 March 2015.

  54. Olsson B, Adamsson Wahren C, Byqvist S. The heavy drug abuse in Sweden 1998 [Det tunga narkotikamissbrukets omfattning i Sverige 1998 MAX-projektet], delrapport 3. Rapport nr. 61. Stockholm: Council for Information on Alcohol and Other Drugs; 2001.

  55. Narcotic Statistics [Narkotika statistik]. Swedish National Council for Crime Prevention [Brottsförebyggande rådet]. Rapport 2010:16. 2010. https://www.bra.se/download/18.cba82f7130f475a2f180001291/1309936539210/2010_16_narkotikastatistik_2009.pdf. Accessed 17 March 2015.

  56. Statistics Sweden. Befolkningsstatistik i sammandrag 1960–2013. 2013. http://www.scb.se/sv_/Hitta-statistik/Statistik-efter-amne/Befolkning/Befolkningens-sammansattning/Befolkningsstatistik/25788/25795/Helarsstatistik—Riket/26040/. Accessed 17 March 2015.

  57. National Board of Health and Welfare [Socialstyrelsen]. Vuxna personer med missbruks- och beroendeproblem samt övriga vuxna. Insatser år 2013. Sveriges officiella statistik. Socialtjänsten. 2014. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/19448/2014-5-14.pdf. Accessed 23 Sep 2014.

  58. Abuse Inquiry [Missbruksutredningen] (SOU 2011:6). Missbruket, Kunskapen, Vården: Missbruksutredningens forskningsbilaga. Stockholm: Frizes. 2011. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CB0QFjAA&url=http%3A%2F%2Fdspace.mah.se%2Fdspace%2Fbitstream%2F2043%2F13752%2F2%2FSOU_2011_06.pdfwebb%2520hela.pdf&ei=WginU4PRHKi_ygOm4YHICQ&usg=AFQjCNEE8GBhFA_EdmivzUd6pffWqzT12A&bvm=bv.69411363,d.bGQ. Accessed 23 Sep 2014.

  59. Swedish Parliament. [Riksdagen]. Drug Penalty Act. 1968. http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/Narkotikastrafflag-196864_sfs-1968-64/?bet=1968:64. Accessed 17 March 2015.

  60. Swedish Prison and Probation Service [Kriminalvården]. Årsredovisning 2013. 2013. http://www.kriminalvarden.se/globalassets/om_oss/arsredovisning_2013pdf. Accessed 17 March 2015.

  61. Månsdotter A, Rydberg M, Wallin E, Lindholm L, Andréasson S. A cost-effectiveness analysis of alcohol prevention targeting licensed premises. Eur J Public Health. 2007;17(6):618–23.

    Article  PubMed  Google Scholar 

  62. Swedish Agency for Economic and Regional Growth [Nutek]. Det sociala företaget och samhället. Socioekonomiska bokslut för Vägen ut! Kooperativen och Basta Arbetskooperativ. R 2006:26; 2006. http://www.sofisam.se/download/18.3453fc5214836a9a472997c3/1411563042781/NUTEK%2C+Det+sociala+f%C3%B6retaget+och+samh%C3%A4llet.pdf. Accessed 23 Sep 2014.

  63. Ekman M, Granström O, Omerov S, Jacob J, Landen M. The societal cost of schizophrenia in Sweden. J Ment Health Policy Econ. 2013;16(1):13–25.

    PubMed  Google Scholar 

  64. Flyckt L, Löthman A, Jörgensen L, Rylander A, Koernig T. Burden of informal care giving to patients with psychoses: a descriptive and methodological study. Int J Soc Psychiatry. 2013;59(2):137–46.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Swedish Civil Contingencies [Myndigheten för samhällsberedskap, MSB]. Samhällets kostnader för vägtrafikolyckor—Beräkningar. 2008. http://www.msb.se. Accessed 23 Sep 2014.

  66. Public Health Agency of Sweden (PHAS) [Folkhälsomyndigheten]. Folkhälsoekonomi i praktiken, R 2011:08; 2011.

  67. Briggs A, Claxton K, Sculpher M. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.

    Google Scholar 

  68. National Board of Health and Welfare [Socialstyrelsen]. Appendices methods. Methods for national guidelines. National Guidelines for psychosocial interventions for schizophrenia 2011—basis for governance and management [Nationella riktlinjer för psykosociala insatser vid schizofreni eller schizofreniliknande tillstånd]. 2011. http://www1.psykiatristod.se/Global/Psykiatristod/Bilagor/schizofreni/Nationella_riktlinjer_psykosociala_insatser_schizofren.pdf. Accessed 23 Sep 2014.

  69. Olmstead TA, Sindelar JL, Easton CJ, Carroll KM. The cost effectiveness of four treatments for marijuana dependence. Addiction. 2007;102(9):1443–53.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Tay-Teo K. Brief cognitive-behavioural intervention for cannabis use disorders. Prevention briefing paper—CBT for cannabis use disorders. 2013. http://www.sph.uq.edu.au/docs/BODCE/ACE-P/ACE-P_briefing_Cannabis_CBT.pdf. Accessed 23 Sep 2014.

  71. United Nations Office on Drugs and Crime (UNODC). Cannabis—a short review, discussion paper. 2014. https://www.unodc.org/documents/drug-prevention-and-treatment/cannabis_review.pdf. Accessed 23 Sep 2014.

  72. Ariza C, Pérez A, Sánchez-Martínez F, Diéguez M, Espelt A, Pasarín MI, Suelves JM, de la Torre R, Nebot M. Evaluation of the effectiveness of a school-based cannabis prevention program. Drug Alcohol Depend. 2013;2013(132):257–64.

    Article  Google Scholar 

  73. Moore T, Zammit S, Lingford-Hughes A, Barnes TRE, Jones PB, Burke M, Lewis G. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370:319–28.

    Article  PubMed  Google Scholar 

  74. Stockholm prevents alcohol and drug problems [Stockholm förebygger alkohol och droger (STAD)]. Ramstedt M, Sundin E, Landberg J, Raninen J. ANDT-bruket och dess negativa konsekvenser i den svenska befolkningen 2013—en studie med fokus på missbruk och beroende samt problem för andra än brukaren relaterat till alkohol, narkotika, dopning och tobak. Rapport nr 55. 2014.

  75. Palamar JJ, Ompad DC, Petkova E. Correlates of intentions to use cannabis among US high school seniors in the case of cannabis legalization. Int J Drug Policy. 2014;25(3):424–35.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–27.

    Article  PubMed  Google Scholar 

  77. Behrendt S, Beesdo-Baum K, Höfler M, Perkonigg A, Bühringer G, Lieb R, Wittchen HU. The relevance of age at first alcohol and nicotine use for initiation of cannabis use and progression to cannabis use disorders. Drug Alcohol Depend. 2012;123(1–3):48–56.

    Article  PubMed  Google Scholar 

Download references

Funding and conflicts of interest

This study was initiated and funded by the Public Health Agency of Sweden. The authors declare they have no conflicts of interest.

Author contributions

All authors contributed to the planning of the study, and all authors approved the final version of the manuscript. The specific contributions by each author were as follows: CD—data collection, analysis, writing of the manuscript; NZ—data collection, analysis; NS—data collection, synthesis of assumptions and co-author discussions; PH—data collection, synthesis of assumptions and co-author discussions; ES—data collection, synthesis of assumptions and co-author discussions; EM-G—data collection, analysis; KN—model construction and design, analysis, manuscript revision; AM—study design, analysis, writing of the manuscript. AM is the principal guarantor of the overall content of this work.

Author information

Authors and Affiliations

  1. Karolinska Institutet, Public Health Sciences, 177 77, Stockholm, Sweden

    Charlotte Deogan, Eva Skärstrand, Edison Manrique-Garcia & Anna Månsdotter

  2. Dental and Pharmaceutical Benefits Agency, Stockholm, Sweden

    Natalie Zarabi

  3. National Board of Health and Welfare, Stockholm, Sweden

    Nils Stenström

  4. Public Health Agency of Sweden, Stockholm, Sweden

    Pi Högberg

  5. Aux Analysis AB, Stockholm, Sweden

    Kristian Neovius

Authors
  1. Charlotte Deogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natalie Zarabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nils Stenström
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pi Högberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Skärstrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edison Manrique-Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kristian Neovius
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna Månsdotter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Månsdotter.

Technical Appendix

Technical Appendix

See Table 7.

Table 7 Probabilities of transition, complications of states, health consequences of states and complications, and applied standard errors
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deogan, C., Zarabi, N., Stenström, N. et al. Cost-Effectiveness of School-Based Prevention of Cannabis Use. Appl Health Econ Health Policy 13, 525–542 (2015). https://doi.org/10.1007/s40258-015-0175-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-015-0175-4

Keywords

Search

Navigation