BUDGET IMPACT ANALYSIS OF THE TRADITIONS AND CONNECTIONS FOR URBAN NATIVE AMERICANS (TACUNA) INTERVENTION
Author(s)
Carolina Barbosa1, Olga Khavjou, MA2, Sophia D'Angelo, MA3, Samuel Mann, PhD4, Daniel Dickerson, MD5, Elizabeth D'Amico, PhD4;
1Research Health Economist, Chicago, IL, USA, 2RTI International, raleigh, NC, USA, 3RTI International, RTP, NC, USA, 4RAND, Santa Monica, CA, USA, 5UCLA, LA, CA, USA
1Research Health Economist, Chicago, IL, USA, 2RTI International, raleigh, NC, USA, 3RTI International, RTP, NC, USA, 4RAND, Santa Monica, CA, USA, 5UCLA, LA, CA, USA
OBJECTIVES: Traditions and Connections for Urban Native Americans (TACUNA) is a culturally grounded prevention program proven to reduce substance use among American Indian/Alaska Native (AI/AN) emerging adults. We conducted a budget impact analysis (BIA) to inform decision making on large scale implementation of TACUNA.
METHODS: We conducted a BIA from a public‑sector perspective to estimate the 10-year impacts of a nationwide implementation of TACUNA. We estimated the size of the eligible population by applying the proportion of 18-25-year-old AI/ANs to the size of the US population in 2025. We collected data on intervention costs and obtained information on federal and state/local expenditures related to the consequences of binge drinking and marijuana use from the literature. We modeled the budget impact by applying the intervention’s risk reductions to estimate decreases in binge drinking and marijuana use and translated those changes into downstream reductions in costs associated with these outcomes. Budget impact was calculated as cumulative net costs over a 10‑year horizon. We estimated uncertainty using probabilistic sensitivity analysis. Costs were adjusted to 2024 dollars.
RESULTS: We estimated that 887,000 US adults would be eligible for TACUNA and that nationwide implementation of TACUNA would cost $277M. In year 1, public-sector costs of binge drinking and marijuana use were estimated to decrease by $106M with a net budget impact of $171M (95% confidence interval [CI]: $154M-$220M). We estimated that savings to the public sector would begin to accrue starting in year 3 post-intervention, and over the 10-year horizon the cumulative savings would reach $1,278M (CI: $616M- $1,510M). Savings persisted after varying assumptions on the sustainability of intervention effects.
CONCLUSIONS: TACUNA demonstrates promising economic value for public‑sector stakeholders. These findings indicate that culturally tailored prevention programs can generate substantial long‑term fiscal benefits while supporting improved substance use outcomes among American Indian/Alaska Native emerging adults.
METHODS: We conducted a BIA from a public‑sector perspective to estimate the 10-year impacts of a nationwide implementation of TACUNA. We estimated the size of the eligible population by applying the proportion of 18-25-year-old AI/ANs to the size of the US population in 2025. We collected data on intervention costs and obtained information on federal and state/local expenditures related to the consequences of binge drinking and marijuana use from the literature. We modeled the budget impact by applying the intervention’s risk reductions to estimate decreases in binge drinking and marijuana use and translated those changes into downstream reductions in costs associated with these outcomes. Budget impact was calculated as cumulative net costs over a 10‑year horizon. We estimated uncertainty using probabilistic sensitivity analysis. Costs were adjusted to 2024 dollars.
RESULTS: We estimated that 887,000 US adults would be eligible for TACUNA and that nationwide implementation of TACUNA would cost $277M. In year 1, public-sector costs of binge drinking and marijuana use were estimated to decrease by $106M with a net budget impact of $171M (95% confidence interval [CI]: $154M-$220M). We estimated that savings to the public sector would begin to accrue starting in year 3 post-intervention, and over the 10-year horizon the cumulative savings would reach $1,278M (CI: $616M- $1,510M). Savings persisted after varying assumptions on the sustainability of intervention effects.
CONCLUSIONS: TACUNA demonstrates promising economic value for public‑sector stakeholders. These findings indicate that culturally tailored prevention programs can generate substantial long‑term fiscal benefits while supporting improved substance use outcomes among American Indian/Alaska Native emerging adults.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE445
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas