Costs and cost-effectiveness of youth smoking prevention policies across seven European countries
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Faculty of Medicine of the University of Porto, Porugal
Publication date: 2018-06-13
Tob. Prev. Cessation 2018;4(Supplement):A101
Tobacco consumption remains one of the most important risk factors of mortality and morbidity, worldwide and in Western Europe. Despite knowledgeable about the dangers of tobacco, a third of European adults, and 12% of US, Canadian and European adolescents still smoke. In order to reduce the smoking prevalence and its consequences, smoking prevention policies have been suggested, but some are not implemented at a large scale due to concerns of high costs and limited effectiveness. In this study we aimed at estimating the costs and cost-effectiveness of five smoking prevention policies (bans on smoking in public places, bans on sales to minors, bans on point-of-sale advertising, bans on smoking at school premises, and school prevention programs), implemented in seven European countries (Finland, Ireland, Netherlands, Belgium, Germany, Italy, and Portugal) in 2016.

We retrospectively collected costs related to (1) the inspection activities and legal procedures related to public bans, (2) the monitoring of the school bans and sanctioning of non-compliant students, and (3) education activities related to smoking prevention programs. We used an “ingredients-based” approach, identifying each resource used, quantity and unit value for one full year, under the State perspective. Costs were measured at national, local, or school-level, and were complemented with qualitative data on how these activities were performed in reality. Cost estimates were estimated at a 17-years’ time horizon to reflect the total number of years of implementation done in the cohort (to cover all groups that have 0 to 17 years old at year 0), discounted at a 3.5% annual rate. Effectiveness was estimated using the DYNAMO-HIA tool, departing from data on short-term prevalence reduction, collected from the literature. The simulation followed the whole population since year 0 until when the last person of the cohort died, estimating the number of healthy life years gained by each intervention, comparing with a no-intervention scenario. Cost estimates were then divided by the total number of healthy life years (QALY) gained by the cohort after the implementation of these policies.

Costs varied between from €0.02 to €0.74 per person for public non-school bans, €0 to €0.48 for school bans, and €0.65 to €5.12 for school programmes, accordingly to the number of person-hours allocated to the implementation of these policies. If effectively implemented, all policies would be cost-effective in all seven countries and levels. School bans would be the most cost-effective interventions, with €0 to €347.50 per QALY. Public non-school bans would cost €0.96 to €1911.18 per QALY, and school programmes would cost €7.08 to €4546.07 per QALY, which are substantially lower than the thresholds proposed by the literature.

Smoking prevention policies targeting adolescents are low cost and highly cost-effective interventions. Investing in these policies and implementing them effectively can tackle one of the main causes of morbidity and mortality in Western Europe.

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