Interventions to Increase High School Completion Rate among School-aged Children and Youth to Promote Health Equity: A Systematic Economic Review

Background: High school completion programs aim to increase the likelihood that students finish high school and receive a high school diploma or complete a general educational development (GED) program. The failure to graduate from high school not only means reduced earnings and health prospects for an individual, but it also presents a greater societal burden in terms of crime and welfare dependency. Because academic achievement is linked with long-term health, and because high school completion programs are commonly implemented in minority or low-income communities, these programs are likely to improve health equity.

The Community Preventive Services Task Force (CPSTF) found strong evidence of effectiveness of high school completion programs in increasing high school completion rates. While a number of economic evaluations of high school completion programs have been conducted, no systematic review of their results has been done so far. This systematic review was conducted to inform the CPSTF about the economic impact of high school completion interventions, assess variability in cost-effectiveness of different types of programs, and compare the lifetime benefit of completing high school to the cost of intervention.

Methods: The economic review of interventions to increase high school completion rate was conducted concurrently with a review of their effectiveness. An economic database search was carried out based on the same search terms used for the effectiveness review, supplemented with economic-focused terms and databases. The author screened and abstracted the economic evidence, categorized, evaluated, and summarized by types of high school completion program.

Results: The economic review identified forty-seven eligible studies published from 1985 to 2012. Thirty-seven studies provided cost-effectiveness ratios on incremental cost per additional high school graduate. Median cost per additional high school graduate for overall high school completion programs was $69.5k with an interquartile interval (IQI) of $35.9k to $130k. Attendance monitoring, mentoring and counseling, vocational training and community service programs had the lowest estimated costs per additional graduate.

Ten studies estimated economic benefit based on the lifetime difference between high school dropouts and graduates in productivity loss and healthcare cost averted, spending on the criminal justice system and welfare payments. Four studies that used a governmental perspective reported benefit per additional high school graduate to range from $187k to $240k, while six studies that used a societal perspective reported a range of $347k to $718k. Benefits exceeded costs in the majority of the studies from a governmental perspective, and in all studies with a societal perspective.

Conclusion: The economic evidence showed that interventions to increase high school completion rates produce substantial economic benefits to government and society. More research is needed concerning information on specific cost components and factors to analyze variation in intervention costs, and the small number of cost-effectiveness studies in skills training, mentoring/counseling, case management, and community service programs.