A Review of Economic Evaluations of Tobacco Control Programs

Abstract

Each year, an estimated 443,000 people die of smoking-related diseases in the United States. Cigarette smoking results in more than $193 billion in medical costs and productivity losses annually. In an effort to reduce this burden, many states, the federal government, and several national organizations fund tobacco control programs and policies. For this report we reviewed existing literature on economic evaluations of tobacco control interventions. We found that smoking cessation therapies, including nicotine replacement therapy (NRT) and self-help are most commonly studied. There are far fewer studies on other important interventions, such as price and tax increases, media campaigns, smoke free air laws and workplace smoking interventions, quitlines, youth access enforcement, schoolbased programs, and community-based programs. Although there are obvious gaps in the literature, the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective.

The Past and Future of Heart Institutes: Having Moved Beyond the One-Trick Pony

“…Government initiatives that have reduced tobacco consumption, including educational campaigns, limiting smoking in public places, and higher cigarette taxes, have been an extremely cost-effective way to reduce cardiovascular disease. 15 Heart institutes should lobby for legislation that improves cardiovascular health across the whole population, including everything from better labelling of food products to more bicycle paths. It could be argued that such an approach goes far beyond our obligation as physicians; however, we should be advocates for our patients, present and future, and preventing cardiovascular events is so much better than treating them.…”

Prioritizing risk factors to identify preventive interventions for economic assessment

“…Examples: tobacco tax raises 1,6 ; mass media campaigns; expansion of quitline use; provision of nicotine replacement products for quitting smoking. Australian researchers found that a national tobacco campaign would be cost-saving.…”

Smoking, health-related quality of life and economic evaluation

“…Economic evaluations of tobacco control policies typically account for the loss of quality of life associated with suffering these diseases by means of health related quality of life (HRQoL) indices that permit the calculation of some outcome measure of life years adjusted by quality. Among such measures, the Quality Adjusted Life Year (QALY) [4,5,21] assigns a value of one to one year of life lived full health and zero to death. A relevant research question, with important implications for policy, is whether smoking affects HRQoL over and above its effect on the likelihood of contracting disease.…”

“…For each of these dimensions respondents can report five levels of severity (no problems/slight problems/moderate problems/severe problems/extreme problems). The resulting 5 5 potential states are mapped into a one dimensional index, known as the EQ-5D-5L "score" or "tariff", usually ranging between unity (representing the best possible outcome of "no problems" in all five dimensions) and zero (worst possible outcome) [22].…”