142 | Noncommunicable Diseases in Saudi Arabia
COST-EFFECTIVENESS OF POPULATION-WIDE INTERVENTIONS The so-called “best-buys” interventions to address NCDs appear to be cost- saving, meaning that the up-front costs of implementation are more than offset by lower health care costs and increased worker productivity. Taking into consideration the available evidence, the WHO (2017) issued recommendations on implementation of the most cost-effective interventions. The WHO guidance is supplemented here with other evidence.
Cost-effectiveness of tobacco control programs Many tobacco control programs appear to be cost-effective. Tax and price increases; smoke-free workplaces, public places, and public transport; plain packaging and health information and warnings; comprehensive bans on tobacco advertising, promotion, and sponsorship; and public awareness campaigns are recognized as the most cost-effective interventions and recommended by the WHO (2017) to reduce tobacco use. Additionally, school-based tobacco control programs, smoking cessation programs, and stepped-up enforcement all appear to be cost-effective or cost-saving in certain circumstances (table 7.16). The extent to which these interventions can be undertaken cost-effectively in Saudi Arabia is unclear. Saudi Arabia has already implemented such policies to varying extents (including antismoking clinics, a mobile antismoking caravan, and an online smoking cessation campaign) (Al-Lehiany and Stanley 2009). A detailed assessment of the country’s current policies—beyond the scope of this book—would be needed to assess whether further efforts would be incrementally cost-effective. The cost-effectiveness of adolescent-targeted e-cigarette control programs has not been assessed. At least one study has shown that school-based e-cigarette control programs and mass media anti-e-cigarette campaigns are effective (Levy et al. 2017a; Milicic et al. 2018), but apparently the cost- effectiveness of such programs has not been evaluated.
Cost-effectiveness of dietary interventions The WHO recognizes interventions to reduce salt intake as cost-effective and recommends that they be implemented. The recommended interventions include reformulating food products, setting target levels for salt in food, establishing a supportive environment in public institutions, communicating information about behavioral changes, implementing FOP labeling, and conducting mass media campaigns (WHO 2017). A review by Hyseni (2017b), however, concludes that mass media campaigns have had only a modest impact on salt reduction. A substantial body of literature suggests that salt reduction reformulation can be both effective and cost-saving (table 7.17). These studies examine mandated or voluntary reductions of sodium levels in processed foods, including bread, processed meats, and sauces (Collins et al. 2014; Nghiem et al. 2015; Nghiem et al. 2016; Rubinstein et al. 2009; Wang and Labarthe 2011; Wilson et al. 2016; Wilcox et al. 2015).
