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Updated: Jan 8, 2026

Measuring the Subjective Value of Risky and Ambiguous Options using Experimental Economics and Functional MRI Methods
Published on: September 19, 2012
An economic analysis of Native CHOICES
Robert Rosenman1, Carolyn Noonan2, Richard F MacLehose3
1School of Economic Sciences, Washington State University, Pullman, WA, 99163, USA.
Introduction:
Fetal alcohol spectrum disorders (FASDs) are a costly collection of conditions caused by alcohol exposed pregnancies (AEPs). Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) is an evidence-based CDC program for AEP prevention. Native CHOICES is a cultural adaptation of CHOICES shown to be effective for reducing AEP risk in American Indian communities. The current study represents the first economic analysis of Native CHOICES.
Methods:
Using pre-pandemic data from a randomized controlled trial of Native CHOICES in a Northern Plains American Indian community, the cost-benefit, cost effectiveness, and quality of adjusted life years (QALY) were assessed for Native CHOICES.
Results:
Native CHOICES lowered AEP risk by 18-20 % during the 6 months following program participation, thus lowering FASDs by an estimated 6.84-7.6 %. Economic analysis of Native CHOICES' impact on lowered AEP and FASD risk revealed Native CHOICES' net economic benefit of $308,295 to $376,951 for the 6 months following the program, with cost efficiency ratios for FASDs avoided ranging from $84,887 to $93,709, and $2330 to $2572 per quality adjusted life years gained.
Conclusion:
Economic analysis results indicate that Native CHOICES is a cost-effective program for AEP and FASD prevention among American Indian participants in the intervention.
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