"Five studies were identified that looked at prevention of methamphetamine use, ecstasy use, cocaine use and general drug use. Evaluated preventive interventions were family-centred programmes; school-based interventions; screening, brief intervention and referral to treatment (SBIRT); and motivational interviewing. The first four were evaluated in a universal population whereas motivational interviewing was evaluated in an at-risk or indicated population.

"Hajizadeh et alReference Hajizadeh, Stevens, Applegate, Huang, Kamboukos and Braithwaite24 evaluated a family-centred intervention, ParentCorps, comparing it with a standard pre-kindergarten programme by using a model that simulated pre-kindergarten children over a lifetime. The societal perspective included healthcare (obesity, diabetes and drug use related), judiciary and productivity in addition to intervention costs. ParentCorps was shown to have a savings of US$4703 and an additional 0.27 QALYs.Reference Hajizadeh, Stevens, Applegate, Huang, Kamboukos and Braithwaite24 In the USA setting, an economic evaluation alongside an RCT evaluated the cost-effectiveness of a family-based intervention, Iowa Strengthening Families Program (ISFP), and a school-based intervention, LST, or a combination thereof, in preventing methamphetamine use. Guyll et alReference Guyll, Spoth and Crowley23 undertook economic analyses using both CEA and CBA. The perspective taken was from the employer and included productivity-related costs in addition to employer-funded healthcare costs. The CEA utilised a 5.5- to 6.5-year time horizon, whereas the modelled CBA evaluated a career-duration time horizon (from 18 to 65 years). ISFP, LST and a combination of LST and an adaptation of ISFP (SFP:10–14 + LST) were found to be effective and cost-effective under CBA. ICERs reported for CEA were US$31 664 (ISFP), US$6377 (LST) and US$78 206 (SFP:10–14 + LST) per past-year methamphetamine use case prevented. Modelled CBA results showed positive benefit–cost ratios of 3.84 (ISFP), 19.04 (LST) and 1.56 (SFP:10–14 + LST).Reference Guyll, Spoth and Crowley23 Another school-based intervention, Social and Emotional Training (SET), was evaluated by Klapp et al in seventh to ninth grade students over 5 years. The study reports an intervention cost of US$596 per student and a benefit of US$8292 from avoided social burden of drug use, equivalent to US$13.9 per dollar spent.Reference Klapp, Belfield, Bowden, Levin, Shand and Zander26 The final universal prevention study evaluated SBIRT compared with no SBIRT, under a healthcare perspective CBA for adults. The study reports annual cost-savings equal to a ratio of US$16 per dollars spent.Reference Paltzer, Moberg, Burns and Brown29

"Pennington et alReference Pennington, Collins, Leigh, Martin, Owen and Fischer30 assessed motivational interviewing for at-risk young gay and bisexual men, and a family-based intervention for newly homeless youth for cocaine use prevention. The modelling used a partial public sector perspective by including healthcare and criminal justice sector costs over a 2-year time horizon. Costs in the model included intervention, criminal justice and cocaine dependence treatment costs (including cocaine-specific hospital admission and cocaine-related cardiovascular treatment). Two motivational interviewing interventions were evaluated against educational videos in gay men. ICERs reported for the motivational interviewing interventions were US$698 549 and US$306 455 per QALY gained. The family intervention was evaluated against standard care by modelling a homeless youth population, and reported an ICER of US$1 500 422 per QALY gained.Reference Pennington, Collins, Leigh, Martin, Owen and Fischer30

"In the Pennington et alReference Pennington, Collins, Leigh, Martin, Owen and Fischer30 study, a targeted prevention strategy, motivational and cognitive behavioural intervention, was modelled for prevention of ecstasy use in people who occasionally use illict drugs. The intervention was modelled over a 1-year time horizon and included similar costs as mentioned previously. The intervention resulted in a ICER of US$731 622 per QALY gained.Reference Pennington, Collins, Leigh, Martin, Owen and Fischer30"


Faller J, Le LK-D, Chatterton ML, et al. A systematic review of economic evaluations for opioid misuse, cannabis and illicit drug use prevention. BJPsych Open. 2023;9(5):e149. doi:10.1192/bjo.2023.515