BACKGROUND: Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US500billionineconomicdamageeachyear.OBJECTIVES:ThispaperexaminesglobalandUKevidenceontheeconomicimpactofsmokingprevalenceandevaluatestheeffectivenessandcosteffectivenessofsmokingcessationmeasures.STUDYSELECTIONSearchmethods:Weusedtwomajorhealthcare/economicresearchdatabases,namelyPubMedandtheNationalInstituteforHealthResearch(NIHR)databasethatcontainstheBritishNationalHealthService(NHS)EconomicEvaluationDatabase;CochraneLibraryofsystematicreviewsinhealthcareandhealthpolicy;andotherhealth−care−relatedbibliographicsources.Wealsoperformedhandsearchingofrelevantarticles,healthreports,andwhitepapersissuedbygovernmentbodies,internationalhealthorganizations,andhealthinterventioncampaignagencies.Selectioncriteria:Thepaperincludescost−effectivenessstudiesfrommedicaljournals,healthreports,andwhitepaperspublishedbetween1992andJuly2014,butincludedonlyeightrelevantstudiesbefore1992.Mostofthepapersreviewedreportedoutcomesonsmokingprevalence,aswellasthedirectandindirectcostsofsmokingandthecostsandbenefitsofsmokingcessationinterventions.Weexcludedpapersthatmerelydescribedtheeffectivenessofaninterventionwithoutincludingeconomicorcostconsiderations.Wealsoexcludedpapersthatcombinesmokingcessationwiththereductionintheriskofotherdiseases.Datacollectionandanalysis:TheincludedstudieswereassessedagainstcriteriaindicatedintheCochraneReviewersHandbookversion5.0.0.Outcomesassessedinthereview:Primaryoutcomesoftheselectedstudiesaresmokingprevalence,directandindirectcostsofsmoking,andthecostsandbenefitsofsmokingcessationinterventions(e.g.,“costperquitter”,“costperlifeyearsaved”,“costperquality−adjustedlifeyeargained,”“presentvalue”or“netbenefits”fromsmokingcessation,and“costsavings”frompersonalhealthcareexpenditure).MAINRESULTS:Themainfindingsofthisstudyareasfollows:1.Thecostsofsmokingcanbeclassifiedintodirect,indirect,andintangiblecosts.About15151 billion. 2. The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers. 3. Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions. 4. The cost per life year saved from the use of pharmacological treatment interventions ranged between US128andUS1,450 and up to US4,400perquality−adjustedlifeyears(QALYs)saved.Theuseofpharmacotherapiessuchasvarenicline,NRT,andBupropion,whencombinedwithGPcounselingorotherbehavioraltreatmentinterventions(suchasproactivetelephonecounselingandWeb−baseddelivery),isbothclinicallyeffectiveandcosteffectivetoprimaryhealthcareproviders.5.Price−basedpolicymeasuressuchasincreaseintobaccotaxesareunarguablythemosteffectivemeansofreducingtheconsumptionoftobacco.A102 to US112perlifeyeargained(LYG)whilereducingsmokingprevalencebyupto30500 and US614perLYG.7.Advertisingmedia,telecommunications,andothertechnology−basedinterventions(suchasTV,radio,print,telephone,theInternet,PC,andotherelectronicmedia)usuallyhavepositivesynergisticeffectsinreducingsmokingprevalenceespeciallywhencombinedtodeliversmokingcessationmessagesandcounselingsupport.However,theoutcomesonthecosteffectivenessofTMT−basedmeasureshavebeeninconsistent,andthismadeitdifficulttoattributeresultstospecificmedia.Thedifferencesinreportedcosteffectivenessmaybepartlyattributedtovaryingmethodologicalapproachesincludingvaryingparametricinputs,differencesinnationalcontexts,differencesinadvertisingcampaignstestedondifferentmedia,anddisparatelevelsofresourcingbetweencampaigns.Duetoitsuniversalreachandlowimplementationcosts,onlinecampaignappearstobesubstantiallymorecosteffectivethanothermedia,thoughitmaynotbeaseffectiveinreducingsmokingprevalence.8.School−basedsmokingprevalenceprogramstendtoreduceshort−termsmokingprevalencebybetween3016,400 to US580,000dependingonthescaleandscopeofintervention.Thecosteffectivenessofschool−basedprogramsshowthatonecouldexpectasavingofapproximatelybetweenUS2,000 and US20,000perQALYsavedduetoavertedsmokingafter2–4yearsoffollow−up.9.Workplace−basedinterventionscouldrepresentasoundeconomicinvestmenttobothemployersandthesocietyatlarge,achievingabenefit−costratioofupto8.75andgenerating12−monthemployercostsavingsofbetween150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce. CONCLUSIONS: We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (i.e., in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers
BackgroundEconomic evidence relating to tobacco control is generally derived from the cost effectiveness of smoking-cessation programs or the economic impact of tobacco-induced disease, based on revealed-preference data. However, empirical estimates from stated-preference data on tobacco users’ preferences, smoking behaviour and smoking cessation aids using analytical techniques such as discrete-choice experiments (DCEs) could be important for policy decision making in tobacco control.ObjectivesOur objective was to review the practice and utility of DCE methodology across nicotine- and tobacco-related issues, particularly smoking and smoking-cessation behaviour, anti-smoking policies and preferences for smoking-cessation aids.MethodsWe searched the PubMed, MEDLINE and ECONLIT databases for full-text original research articles on tobacco-related issues published between January 2000 and April 2016 that used a DCE method. We summarised the evidence and methodological characteristics of DCEs according to Lancsar and Louviere, 2008.ResultsOur review of the 12 eligible studies showed that DCE methodology was used to elicit smoker preferences and to evaluate tobacco-control policies. The majority of the studies were published in the last 5 years. The areas of application were smoking cessation, smoking behaviour, electronic cigarette use, water-pipe smoking and tobacco packaging. Monetary attributes were the most influential attributes in all studies. The design of the DCEs varied.ConclusionDCE studies of tobacco-related issues were methodologically consistent with guidelines proposed for conducting health-related DCEs
Use of substances including alcohol, tobacco and drugs is common in people of reproductive age, can lead to dependence and is a major global health concern. Despite targeted public health policies and campaigns, population surveys (National Institute on Drug Abuse (NIH) 2020; European Drug Report 2019) continue to highlight widespread use of substances, often in combination, which have substantial negative implications for health in general and the potential to harm future generations (Stephenson et al. 2018). Healthcare professionals need to be aware of the complex psychological, physiological and social factors that may be linked to substance use and be prepared to offer counselling and referral for specialist services. Pregnancy, however, can be a ‘window of opportunity’ and a motivating factor for women and their partners to change their behaviour and minimise risk with help to quit or cut down on substance use (Solomon and Quinn 2004). Preconception care offers the opportunity to further reduce risk by helping to modify consumption prior to pregnancy