. 2007 Nov;97(11):2020–2027. doi: 10.2105/AJPH.2006.105478

TABLE 3—

Cost-Effectiveness Values From Societal and Governmental Perspectives for All Students and for Students Receiving Free Lunches

Strategy	Total Lifetime Costs,^a $	Incremental Cost,^a $	Total Quality- Adjusted Life- Years^b (SE)	Incremental Quality- Adjusted Life- Years^b Gained	Incremental Cost- Effectiveness, $
All students
Societal perspective^c
Small classes	–454 294	–168 431	19.7 (0.09)	1.7
Regular classes	–285 863		18.0 (0.06)		. . .^d
Governmental perspective^e
Small classes	60 038	25 685	19.7 (0.09)	1.7	15 415
Regular classes	34 353		18.0 (0.06)
Free-lunch students
Societal perspective^c
Small classes	–482 129	–196 266	19.7 (0.10)	1.5^f
Regular classes	–285 863		18.0 (0.06)		. . .^d
Governmental perspective^e
Small classes	24 615	–9 738	19.7 (0.10)	1.5^f
Regular classes	34 353		18.0 (0.06)		. . .^d

Note. Incremental values represent the cost or effectiveness of small class sizes minus the cost or effectiveness of regular-sized classes.

^aLifetime earnings of students are greater than costs of schooling; thus, societal values are negative.

^bA quality-adjusted life-year is calculated from the health-related quality of life scores. These scores were scaled from 0 to 1.0, with 0 representing death and 1.0 representing perfect health. Ten years lived at a health-related quality of life rating of 0.7 is equal to 7 (10 × 0.7) quality-adjusted life years. A quality-adjusted life-year is a year of perfect health.

^cThe societal perspective incorporated individual income earnings and quality-adjusted life-years.

^dBoth more expensive and less effective than small classes.

^eThe governmental perspective incorporated public expenditures and revenues only.

^fDifferences here were because of rounding. Free-lunch students were assumed to have lower rates of college attendance, thus resulting in slightly lower predicted gains in quality-adjusted life-years.