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The DES model predicts the course of a disease naturally, with few restrictions. This may give the model superior face validity with decision makers. Furthermore, this model automatically provides a probabilistic sensitivity analysis, which is cumbersome to perform with a Markov model. DES models allow inclusion of more variables without aggregation, which may improve model precision. The capacity of DES for additional data capture helps explain why this model consistently predicts better survival and thus greater savings than the Markov model. The DES model is better than the Markov model in isolating long-term implications of small but important differences in crucial input data.

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Commentary It has been nearly 10 years since the state attorneys general banded together in a concerted legal effort to recover the costs of caring for smokers who had developed cigarette-related illnesses. To avoid possible bankruptcy, tobacco industry companies agreed to a legal settlement known as the Master Settlement Agreement (MSA). With the MSA, states obtained a 25-year payout of hundreds of billions of dollars from "Big Tobacco." In addition, the tobacco industry was forced to make other concessions regarding how cigarette advertising and other products were targeted at youths, meant to decrease smoking nationwide. In return, the 46 states that were parties to the MSA agreed to drop their pending individual and collective litigation against the tobacco industry. The impact of the settlement is the subject of much debate. Here we look back at the MSA, how it was implemented, its possible impacts, and the lesson it provides physicians about health policy-making realities in the United States. Historical PerspectiveThe original purpose of the MSA must be put into the broader context of the history of the antitobacco movement in the United States. The use by states of MSA funds has evolved over the last decade, and thisThe issue of tobacco industry responsibility for population health problems and compensation for their treatment has been growing since the 1960s. In 1999, the state attorneys general collectively launched the largest class action lawsuit in US history and sued the tobacco industry to recover the costs of caring for smokers. In what became known as the Master Settlement Agreement (MSA), states were rewarded billions of dollars and won concessions regarding how cigarettes could be advertised and targeted to minors. Ten years after this settlement, much is known about how MSA monies were distributed and how states have used the money. There is some understanding about how much of the money went toward offsetting the health-care costs attributable to smoking and whether resources were allocated to efforts to reduce smoking in a particular state. However, there are few data on what effect, if any, the MSA had on tobacco control locally and nationally. This commentary explores these issues, as well as how the tobacco industry has evolved to offset the losses incurred by the settlement. Finally, an analysis of the complexities of current tobacco policy making is provided so that physicians and other health-care advocacy groups can more completely understand the present-day political dynamics and be more effective in shaping tobacco control policy in the future.