Cost effectiveness of tobacco control

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3 - Progress in Australia on recommended policies and programs

A study of the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality and costs has recently been conducted in the United States. It found that approximately 78% of adults aged 20 to 80 years alive today are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced by approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the US adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults.

Of the specific prevention activities, the greatest benefits to the US population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years.

Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.[217]

When Maciosek et al. recently prioritised 25 preventive interventions, factoring in burden of disease and cost effectiveness, tobacco control was tied for the top priority, and better screening followed by brief intervention yielded a greater benefit in quality-adjusted life-years than the next 10 interventions combined.[218, 219]

Researchers at the Johns Hopkins Bloomberg School of Public Health and the American Legacy Foundation have estimated that truth®, the nations’ largest youth smoking prevention campaign, saved $1.9 billion or more in healthcare costs associated with tobacco use.[220] Using standard methods of cost and cost-utility analysis, Holtgrave and colleagues compared the costs of the truth® campaign to the absence of the campaign. The American Legacy Foundation spent $324 million to implement and evaluate the truth® campaign. The authors have compared the cost of the program to its healthcare savings, and found that both base and optimistic case results indicate cost savings over and above the campaign’s initial costs. Even the most pessimistic case analysed indicated that the intervention is cost effective to society.
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A study analysing data from the Swedish Medical Birth Register has demonstrated that quitting smoking reduces the risk of infant death, particularly deaths among infants four to 15 weeks old.[221]

A study using 30-year follow-up data found that self-reported smoking cessation after coronary artery bypass surgery was associated with a life expectancy gain of three years. Smoking cessation turned out to have a greater effect on reducing the risk of mortality than the effect of any other intervention or treatment.[222]

Potential modest cost savings may accrue with implementation of an institution-based smoking cessation program for patients undergoing total hip and knee arthroplasties through reduced total hospitalisation costs that exceed the cost of the intervention.[223]

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