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TABLE 7.16 Evidence
on cost-effectiveness of tobacco control interventions
INTERVENTION
RESEARCH FINDINGS
REFERENCES
School-based tobacco control programs
School-based tobacco-use prevention programs are highly cost-effective, compared with other widely accepted prevention interventions. A program in the United States, which cost US$16,403, prevented 34.9 students from becoming established smokers and resulted in savings of $13,316 per life year saved and savings of US$8,482 per QALY saved. A program in India cost US$2,057 per QALY saved, even without accounting for medical costs averted. A systematic review of smoking prevention policies and programs among adolescents concludes that they were greatly worth their costs.
Brown et al. 2013; Dino et al. 2008; Leão, Kunst, and Perelman 2018; Wang et al. 2001
Smoking cessation programs
Implementation of current smoking cessation services in Spain has a lifetime benefit-cost ratio of 5 compared with no such provision. It would be cost-effective to expand current service provision by providing proactive telephone support and reimbursing the cost of smoking cessation medication for smokers trying to stop. The lifetime benefit-cost ratios were 1.87 (proactive telephone calls), 1.17 (prescription nicotine replacement therapy), 2.40 (varenicline-standard duration), and bupropion (2.18).
Guerriero et al. 2013; Levy et al. 2017a; Németh et al. 2018; Popp et al. 2018; Trapero-Bertran et al. 2018
The cost of text-based support per 1,000 enrolled smokers in the United Kingdom was £16,120, which, given an estimated 58 additional quitters at six months, equates to £278 per quitter. However, when the future UK National Health Service costs saved (as a result of reduced smoking) are included, text-based support would be cost-saving. Providing text-based support to smokers trying to quit gained an estimated 18 life years (0.3 life year per quitter) and 29 QALYs (0.5 QALY per quitter) per 1,000 smokers. Introducing a social marketing campaign in Hungary resulted in an increase of 0.3 additional quitter per 1,000 smokers, translating to health care cost savings of €0.65 per smoker compared with current practice. When the value of QALY gains is considered, cost savings increase to €14.16 per smoker. Stepped-up enforcement
Enforcement of tobacco sales laws is inexpensive, typically paid for by license fees, and very efficient in terms of cost per year of life saved; it could be fully funded with a US$0.01 per pack tax on cigarettes, with no need to divert resources from other programs.
Source: Original compilation for this publication. Note: QALY = quality-adjusted life year.
A salt reduction program in the United Kingdom that included reformulation as one component of a multicomponent strategy seems to have been cost- effective. The components of the program included establishing targets for different categories of food, with an explicit time frame for industry to achieve those targets, clear nutritional labeling, and a consumer awareness campaign. A modeling study based on this intervention finds it to be cost-saving (SmithSpangler et al. 2010). However, it is impossible to disentangle the effects of reformulation from other aspects of the program such as nutrition labeling. At least two modeling studies suggest that voluntary reformulation of high-salt products is both effective and cost-saving, but less so than mandates. A study in Australia finds that a voluntary salt reduction program would be cost- effective, but that health benefits would be 20 times greater with government legislation (Cobiac, Vos, and Veerman 2010). A study in the United Kingdom finds that both voluntary and mandatory reformulation to reduce salt are cost-saving, but mandatory reformulation is even more cost-saving (Collins et al. 2014). Mass media salt reduction campaigns may be cost-effective or cost-saving. As noted above, the efficacy of such campaigns is thought to be modest (Hyseni 2017b), but several modeling studies have reported that they are, in fact, cost- saving (Collins et al. 2014; Nghiem et al. 2015).
DiFranza et al. 2001
