Economic evaluation of tobacco control in Asia:Dynamic population health impact assessment in Mongolia

More than half of the world’s 1.3 billion smokers live in Asia and this continent is the largest tobacco consumer as well as producer. The tobacco smoking epidemic is still in its early stages and will remain a major public health threat in the coming decades. However, the use of evidence for prioritizing tobacco control interventions is limited, especially in low-middle-income countries. This is partly due to a lack of good quality evidence that is tailored to the local context. This thesis adds to tailored evidence to inform on the efficiency of tobacco control interventions in Asia. A literature review indicates that previous studies employed relatively little local data sources and suboptimal model structures when investigating the cost-effectiveness of population based tobacco control interventions. Then, for Mongolia, tailored evidence was gathered: the attributable fraction of lung cancer burden caused by tobacco smoking was 58% for men, while for women it was only 9%. The mean annual inpatient cost for patient with three major noncommunicable diseases were $721, or almost five times the per capita health expenditure ($149). Patients using self-referral had higher hospital costs.Combining all evidence, using taxes to increase cigarette prices by 75% (bringing the country up to the level suggested by the WHO) would reduce the prevalence of smoking by 1.2%points and gain more than 137 thousand quality-adjusted life years in the population of three million individuals. Mass media campaigns, tobacco taxation, school programs and cessation support were all very cost-effective, while the school program was cost-saving

In vivo triglyceride synthesis in subcutaneous adipose tissue of humans correlates with plasma HDL parameters

Backgrounds and aims: Low concentrations of plasma HDL-C are associated with the development of atherosclerotic cardiovascular diseases and type 2 diabetes. Here we aimed to explore the relationship between the in vivo fractional synthesis of triglycerides (fTG) in subcutaneous (s.q.) abdominal adipose tissue (AT), HDL-C concentrations and HDL particle size composition in non-diabetic humans. Methods: The fTG in s.q. abdominal AT was measured in 16 non-diabetic volunteers (7 women, 9 men; Age: 49 ± 20 years; BMI: 31 ± 5 kg/m; Fasting Plasma Glucose: 90 ± 10 mg/dl) after 2H2O labeling. HDL-C concentration and subclasses, large (L-HDL), intermediate (I-HDL) and small (S-HDL) were measured. Results: Linear regression analyses demonstrated significant associations of fTG with plasma concentration of HDL-C (r = 0.625,p = 0.009) and percent contribution of L-HDL (r = 0.798,p < 0.001), I-HDL (r = -0.765,p < 0.001) and S-HDL (r = -0.629, p = 0.009). When analyses were performed by gender, the associations remained significant in women (HDL-C: r = 0.822,p = 0.023; L-HDL: r = 0.892,p = 0.007; I-HDL: r = -0.927,p = 0.003) but not men. Conclusions: Our study demonstrated an in vivo association between subcutaneous abdominal adipose tissue lipid dynamics and HDL parameters in humans, but this was true for women not men. Positive association with L-HDL and negative with I-HDL suggest that subcutaneous abdominal adipose tissue lipid dynamics may play an important role in production of mature functional HDL particles. Further studies evaluating the mechanism responsible for these associations and the observed gender differences are important and warranted to identify potential novel targets of intervention to increase the production of atheroprotective subclasses of HDL-Cs and thus decreasing the risks of development of atherosclerotic conditions

Cost-Effectiveness of Four Tobacco Control Interventions in Mongolia.

INTRODUCTION: The aim of this study is to quantify the cost-effectiveness of four tobacco control interventions: Tobacco taxation, mass media campaigns, school programs, and cessation support, and to illustrate how available evaluation tools can be adapted to the local setting. AIMS AND METHODS: We used the dynamic population health modeling-health impact assessment tool to project the future smoking prevalence associated with the interventions and to simulate the resulting smoking-related disease burden over time. Applying the most recent available national Mongolian data as input, the costs and effects of four interventions were compared to a business-as-usual scenario, resulting in costs per life year gained and per disability-adjusted life years (DALYs) averted. RESULTS: Three years after implementation, all interventions reduce the prevalence of current smoking, with the strongest reduction observed with the increase in tobacco tax (5.1% points), followed by mass media campaigns (1.6% points), school programs (1.3% points), and cessation support interventions (0.6% points). School programs were a cost-saving tobacco control intervention compared to current practice in Mongolia, while the other programs resulted in additional costs compared to business as usual. Compared to the World Health Organization (WHO) thresholds, all interventions would be considered "very cost-effective" in terms of cost per DALY averted (below US$4295 per DALY averted) in Mongolia. CONCLUSIONS: Large-scale interventions such as taxation and mass media campaigns result in both cost-effectiveness and important health benefits in relation to intervention costs. Reducing the prevalence of smoking among the male population would be particularly worthwhile in Mongolia. IMPLICATIONS: This study shows that in Mongolia school programs were a cost-saving intervention, while the cost-effectiveness ratios were US$ 25 per disability-adjusted life year (DALY) averted for mass media campaigns, US$74 for taxation, and US$ 1961 for cessation support interventions. Compared to the WHO thresholds, all interventions would be considered "very cost-effective" in terms of expenses per DALY averted (&lt;US$ 4295 per DALY averted), making it beneficial to scale up the WHO-Monitor tobacco use and prevention, Protect people from smoke, Offer help to quit smoking, Warn about the danger, Enforce bans, and Raise taxes (MPOWER) interventions to reduce the burden from smoking in Mongolia.</p