Investing in Infrastructure: A Mixed-Methods Cost Analysis of Implementation Strategies to Address Emerging Youth...

Schools engaged in prevention efforts struggle to respond quickly and effectively to changing drug use trends due to insufficient investment in infrastructure at local, state, and national levels. This results in preventable morbidity and mortality among adolescents. This study estimated the costs associated with implementing Rapid Adaptation to Prevent Drug use (RAPD) infrastructure-building implementation strategies, using mixed methods to optimize data collection feasibility and quality and to support a comprehensive understanding of outcomes.

We conducted semi-structured interviews in Step 1 (pre-pilot trial) to inform the initial cost data collection approach. In Step 2, we used activity-based costing, conducted a sensitivity analysis, and estimated the budget impacts of replication. Step 3 included interviews with pilot participants to contextualize the results and verify time reporting.

Thirty-four school personnel participated in Step 1 interviews, and four health coordinators and six teachers participated in the pilot study. We identified cost drivers and pragmatic constraints related to effective time-cost data collection and developed an activity-based costing data collection plan. The estimated cost of deploying RAPD (Step 2) was $6,215/school. We estimated the budget impact of replication to be $5,551/school, with 52% of the cost incurred during the pre-implementation phase. In Step 3 interviews, participants identified financial and staffing resources as central challenges to infrastructure development.

This study used a mixed-methods approach, incorporating an exploratory sequential design, to proactively guide microcosting. By identifying potential barriers in advance, we enhanced the rigor and feasibility of the data collection process. This study provides preliminary cost estimates for deploying RAPD infrastructure-building strategies to address emerging drug trends and sustain prevention efforts.