Tobacco control interventions are an excellent investment. A review of economic evaluations of tobacco control programs published in 2009 concluded: 'the existing studies show in almost every case that tobacco control programs and policies are either cost-saving or highly cost-effective'.1 A 2010 Australian report that examined the cost-effectiveness of 150 disease prevention interventions predicted that a tobacco taxation increase (of 30%) would not only be cost-saving, but was the intervention that would have the highest health benefit—270 000 DALYs prevented.2
The following sections summarise studies that have investigated the cost-effectiveness of tobacco control per se, policy interventions, population-based strategies and clinical interventions. The focus is on Australian studies; international research is included for interventions that have been undertaken in Australia but have not been evaluated.
The cost-effectiveness of tobacco control per se has been studied in the following four types of analyses:
The largest comprehensive tobacco control program in the world to date is the California Tobacco Control Program (CTCP).3 It began in 1989, with an annual budget of about $100 million. In addition to the tobacco tax increase that financed the program, the CTCP involved an anti-tobacco media campaign and community- and school-based interventions.4 As well as directly encouraging people to quit, the CTCP has included vigorous efforts to discourage smoking around others, backed up by some of the most far-reaching legislation seen anywhere in the world mandating smokefree public places. Changing social norms about smoking has also been shown to have contributed to the dramatic decline of smoking in California.5 An economic evaluation investigated the impact of tobacco control on Californian men alive in 1990 over their subsequent life until 2079, when the youngest would turn 90. The value of the net health care savings and years of life saved was about $22 million (in 1990 dollars, discount rate of 3% per annum).6 So the CTCP was cost saving as well as effective.
Several Australian analyses have assessed the economic efficiency of comprehensive tobacco control programs; two evaluated actual programs retrospectively and one analysis assessed a proposed package of interventions. Economists have also estimated the likely social returns of reduced prevalence of smoking in various states and nationally.
The consulting group Applied Economics evaluated the return on investment in Australian public health programs.7 They found that from the late 1960s to late 1990s male smoking rates dropped from 45 to 27% and female rates dropped from 30 to 23%. By 1996, tobacco expenditure per capita had dropped to less than 40% of its 1965 level. Applied Economics estimated that Australian public health programs aimed at reducing tobacco consumption had cost $176 million over that 30-year period, but had saved $8.06 billion (yr 2000 dollars, discounted back to 1971). In other words, Australian tobacco control programs have been cost saving. Furthermore, the analysis found that the government saved $2 for every $1 it spent on public health programs to reduce smoking.
Hurley and Matthews evaluated the Australian National Tobacco Campaign (NTC) initiated by the federal government in 1997.8 The NTC involved intensive television broadcasting of new anti-smoking advertisements and increased funding for support services for smokers attempting to quit. The cost-effectiveness analysis found that the NTC was both cost saving and effective. The campaign cost about $9 million, but predicted health care cost savings exceeded $740 million. About 55 000 deaths were predicted to be prevented and over 400 000 QALYS saved.
The Cancer Council Victoria submitted a report in 2009 to the National Preventative Health Taskforce analysing the potential impact of more intensive tobacco control strategies than the anti-smoking social marketing campaign funded under the National Partnership Agreement on Preventative Health (NPAPH) and scheduled to start that year.9 The report predicted that tobacco taxation increases, combined with additional spending on anti-smoking media, would achieve the Taskforce's goal of a smoking prevalence of 10% or less by 2020 and would avoid 248 200 premature deaths. Such a program was estimated to cost about $276 million, but would save more than $5 billion in health care costs.
In their reports to state governments in Victoria, Western Australia and New South Wales, Collins and Laplsey have not just quantified recent social costs of smoking but have also estimated the social returns that could be expected from future reductions in smoking prevalence.10–12
The 1998 Master Settlement Agreement with the tobacco industry in the United States made funding available to states for tobacco control programs. Implementation of such programs has varied between states.13 It is therefore feasible to investigate the correlation, at state level, between tobacco control expenditure and health and health economic outcomes. Such analyses have found that in states that increased tobacco control program funding there were decreases in aggregate cigarette sales,13 lower prevalence of youth smoking,14 more rapid falls in cardiovascular death rates15 and reduced personal health care expenditures.16
Three Australian analyses have modelled the impact of reduced smoking on specific health economic outcomes. The first analysis was published in 2004,17 in the context of the federal government's Intergenerational Report (IGR) which predicted large increases in the cost of government subsidies of medicines under the Pharmaceutical Benefits Scheme (PBS) consequential to an ageing population.18 The economic analysis predicted that if smoking prevalence were reduced by 5%, savings in PBS subsidies for drugs to treat smoking-related cardiovascular disease would exceed a billion dollars over the 40-year period of the IGR. If the 5% reduction in smoking rate could be achieved at a cost of $45 million, the program would have an internal rate of return of 33% and the initial investment would be recouped in eight years.
The second analysis investigated the impact of reductions in the smoking rate on acute myocardial infarction hospitalisations and costs.19 A model previously used to predict these outcomes for the United States and the United Kingdom was updated and applied to the Australian population.20,21 The analysis predicted that if smoking prevalence dropped by 5%, more than 3000 hospitalisations for myocardial infarction and 1000 hospitalisations for stroke would be avoided over only a seven-year period. Health care costs would be reduced by $61.6 million, almost 3% of the total hospitalisation costs for stroke and heart attack over the period.
Smoking increases the risk of the eye disease, age-related macular degeneration, by 2.5-fold to 4.5-fold. Hurley and Matthews found that smoking cessation is unequivocally cost-effective in terms of its impact on age-related macular degeneration.22 Their model predicted that if 1000 smokers quit, there would be 48 fewer cases of macular degeneration, 12 fewer cases of blindness and the costs of treating and caring for people with macular degeneration would decrease by $2.5 million. If the tobacco control program that facilitated quitting cost less than $1400 per quitter, it would be cost-saving in terms of its impact on macular degeneration alone.
In the United States, Lightwood et al. estimated the impact of a pregnant woman stopping smoking before the end of the first trimester on pregnancy- and birth-related outcomes.23 They predicted that a 1% national drop in smoking prevalence would prevent 1300 low birth weight live births and save $21 million in one year alone (1995 US dollars).
Governments can increase the price of cigarettes through increased taxation rates, thereby potentially decreasing demand. Wakefield and colleagues analysed the impact of tobacco control policies and programs on Australian smoking prevalence over the period 1995–2006.24 They found that increases in cigarette costliness (defined as the ratio of the average price of a pack of cigarettes to the average weekly earnings) were associated with decreases in smoking rates. An increase of 0.03% in costliness decreased smoking prevalence by 0.3%. This finding is in line with established international estimates of price elasticity of demand25 as well as results of a more recent systematic review which included an estimate of price elasticity from studies that control for non-price related interventions.26 Ranson et al. used standard cost-effectiveness analysis methodology (see Section 22.214.171.124) to evaluate price increases through taxation.27 Although the 'cost' of a cigarette taxation increase would appear to be zero, Ranson and colleagues conservatively assumed that tax increases would involve enforcement costs for collection of the taxes. They found that a 10% price increase would cost on average between US$12 and US$313 per DALY saved, depending on assumptions about enforcement costs and price elasticity (the net impact of a price change on the demand for cigarettes). This analysis therefore indicates that taxation is a very cost-effective tobacco control intervention and the Australian report, mentioned in Section 17.4, that found a tobacco taxation increase (of 30%) to be cost-saving, confirms this finding.2
Smokefree workplaces reduce cigarette consumption among continuing smokers and lead to increased successful cessation among smokers.28 Strong restrictions significantly reduce both smoking prevalence and average daily cigarette consumption for youth and young adults.32,33
Restrictions on smoking in public and work settings also influence the health and wellbeing of people who do not smoke.
Policies that ban smoking in public places are associated with significant reductions in both the prevalence of exposure to secondhand smoke and the prevalence of smoking. This can be expected to lead to a reduction in smoking-related diseases and therefore in health care costs.28 A US study analysed the effect of a smokefree policy in workplaces and public places on the number of hospital admissions for smoking-related diseases.34 The city of Bowling Green, Ohio, implemented a clean indoor air ordinance in March 2002. Smoking was prohibited in all public places within the city, except for bars and restaurants with bars, provided that the bar area was isolated within a separate smoking room. Following introduction of the ordinance, admissions to the local hospital were significantly reduced. Admissions for coronary heart disease decreased by 39% after one year and by 47% after three years, resulting in significant cost savings. Since this study, several others have also reported dramatic reductions in admissions for myocardial infarction and other diseases following the implementation of such policies.35–37
Another US study examined the effect of making all workplaces smokefree and concluded that the combined impact of increased numbers quitting, reduced smoking by the remaining smokers and reduced exposure to secondhand smoke would result in substantial savings in medical costs in just the first year.38
Cigarette advertising conveys information about the product's physical characteristics and 'personality'. Such advertising is designed primarily to create:
'fantasies of sophistication, pleasure, social successes, independence or ruggedness. This process can induce individuals who are not smokers to try the product, for those are smokers, to smoke more, for those might have quit, to continue and for those who have quit, to start again.' (Saffer and Chaloupka,39 Section 2, para 2).
Advertising can also increase market size by assisting brand proliferation. New brands may induce people to take up smoking thereby increasing total tobacco consumption.
An econometric study prepared for the World Bank compared changes in tobacco consumption in countries that had introduced advertising bans.40 Controlling for price, income and other factors affecting demand, they found that limited bans are minimally effective. Comprehensive bans, however, do reduce tobacco use.
In Australia, Applied Economics completed a cost-benefit analysis of new health warnings on cigarette packs prior to their introduction in 2004.41 The new warnings comprised 14 rotating graphic messages covering 50% of the front and back of the cigarette packs Assuming that the new warnings would result in a 3% decrease in smoking rates, the analysts forecast a net benefit of more than $2 billion and a benefit:cost ratio greater than 2:1.
In all Australian states and territories, the minimum legal age for purchase of cigarettes is 18 and the distribution of free samples is prohibited.42 The vigour with which such laws are enforced has varied in different jurisdictions over time in Australia.43 Two recent analyses suggest that strengthening of laws banning sales to minors in Australia may have contributed to the dramatic declines in youth smoking observed in recent years.44,45
A cost-effectiveness analysis of programs enforcing the prohibition of tobacco sales to minors has been conducted for the United States.46 Reliable data on the effectiveness of such programs was unavailable,47 but the analysts estimated that if enforcement decreases the prevalence of youth smoking by 5%, the cost per life-year saved would range from $440 to $3100. Enforcement programs are therefore cost-effective, even if their impact on smoking rates is small.
Media campaigns in Australia have clearly been effective in reducing smoking prevalence.48–53 The time series analysis of Australian smoking prevalence data from 1995 to 2006, referred to in Section 126.96.36.199, also investigated the impact of televised anti-smoking advertisements24 finding that exposure to advertisements four times a month, on average, decreased smoking prevalence by 0.3%. A Cochrane Collaboration review of 11 trials of mass media designed to promote smoking cessation also found that such programs can be effective.54 A more extensive review of multiple sources of evidence conducted by the US National Cancer Institute found overwhelming evidence that such campaigns can be highly effective, depending on the kinds of advertisements used, and the weight of media advertising.55
Mass media campaigns can also be cost-effective. A study of Scotland's 1992 campaign and an analysis of a four-year media campaign in the United States that targeted adolescents both reported costs per life-year saved below $1000 (2005 US dollars).1,56,57
Telephone quitlines offering counselling and self-help materials operate in all Australian states and territories. A Cochrane review has concluded that telephone counselling can increase success rates in those interested in quitting58 and that multiple call-back counselling sessions improve long-term cessation.59 At least one US study has concluded that offering telephone counselling to quitline callers is cost-effective.60 Callers were randomised to receive mailed self-help booklets or booklets plus telephone counselling. The quit rate 12 months after randomisation was 4.5% higher in the counselled group and the cost for each additional year of maintained smoking cessation was $1300 (US dollars, 2000). A Swedish study assessed the 12-month quit rate for more than 1000 callers to the national quitline.61 More than 30% of callers quit and the cost per life-year saved was estimated at between $311and $401 (US dollars, 2002). Several studies have concluded that providing NRT through quitlines increases cost-effectiveness.62–64
Group counselling sessions are also effective but less popular and much more expensive.65 Internet and mobile phones for smoking cessation may also be effective.66,67 The high reach and low cost of such interventions could greatly increase the cost-effectiveness of smoking cessation services.
The main clinical tobacco control interventions are advice to stop smoking and pharmacotherapies. Advice can be brief or more intensive, involving repeated counselling sessions, and can be delivered by a doctor or other health professional, in general practice, specialist or health care settings. A Cochrane Collaboration review concluded that simple advice by a physician to stop smoking does increase quit rates.68 The absolute improvement is small—if the unassisted quit rate is 2 to 3%, a brief advice intervention can increase quitting by 1 to 3%. More intensive interventions further increase the quit rate, to a small extent. Because advice to quit smoking is inexpensive, and because the health and economic benefits of quitting are large, smoking cessation advice has long been recognised as very cost-effective intervention. For example, a review by Brown and Garber found that physician or nurse smoking cessation counselling had cost-effectiveness ratios less than $5000 per life-year saved.69 Table 17.4.1 summarises key cost-effectiveness ratios from their review for smoking cessation advice and other coronary heart disease prevention strategies. Smoking cessation advice was more cost-effective than most of the other prevention strategies considered.
Cost-effectiveness league table of interventions to reduce coronary heart disease morbidity and mortality
Mass-media program to reduce dietary cholesterol
5-minute medical advice on smoking cessation
Coronary artery bypass grafting
Propranolol (a beta blocker) for hypertension
Exercise electrocardiogram as screening test
Source: Adapted from Brown and Garber,69 Table V. Refer to the original publication for details of the risk profiles of the people receiving the intervention
Reviews of studies of smoking cessation counselling by other health professionals suggest that pharmacists in community settings may be effective in increasing quit rates among their patients70 and that more research is required to assess the efficacy of counselling by dentists.71 Cochrane reviews confirm the effectiveness of smoking cessation programs that commence after hospital admission and continue after discharge.72 Advice from nurses in the hospital setting also seems to increase quit rates.73 Little work has been undertaken on the cost-effectiveness of smoking cessation in these settings. Several studies have established the feasibility and accessibility of referral by health professionals to government-run Quitlines.74 This model has potential to increase both the number of patients receiving counselling and quit rates among those who do,75 thereby increasing the cost-effectiveness of clinical interventions,
Smoking cessation guidelines for doctors now recommend that smokers who wish to quit be offered pharmacotherapy.76 Three pharmacotherapies are available: nicotine replacement therapy (NRT), bupropion and varenicline. NRT is available as transdermal (skin) patches, gum, inhaler and lozenges. As mentioned in Section 188.8.131.52, the Pharmaceutical Benefits Advisory Committee (PBAC) recommends to the Minister for Health which drugs should be subsidised under the Pharmaceutical Benefits Scheme. A medicine must be effective and cost-effective in order to be subsidised.77 The three available smoking cessation pharmacotherapies have each been recommended for subsidy by the PBAC; they are all regarded as 'cost-effective'. At the time of writing this Chapter (September 2010) the government was still considering the PBAC's recommendation to subsidise the transdermal patch form of NRT.78
Three Australian studies have analysed the relative cost-effectiveness of these smoking cessation pharmacotherapies.78–80 Two studies found bupropion more cost-effective than NRT,79,81 and one study found varenicline more cost-effective than both NRT and bupropion.80 However, these comparative cost-effectiveness findings are dependent on the cost of a course of each therapy and the analysts' assumptions about relative effectiveness. A PBS-subsidised course of nicotine patches is now cheaper than a course of bupropion or varenicline. The PBAC regards nicotine patch as safer and cheaper than bupropion and view the two drugs as having comparable efficacy. Compared with varenicline, the PBAC views nicotine patch as being cheaper and safer but regard the comparative efficacy as being uncertain, with nicotine patch being possibly inferior.78 The one head-to-head randomised trial of varenicline and nicotine patch reported a marginally statistically significant higher quit rate in smokers assigned to varenicline therapy.82,83
Reviews have concluded that smoking cessation advice and assistance to quit smoking is one of the most cost-effective disease prevention services available in clinical settings. In the United States, Maciosek and colleagues developed a methodology to prioritise clinical preventive services based on two measures: (i) the clinically preventable burden of disease, defined as the total number of QALYs that could be saved; and (ii) its cost-effectiveness, defined as the average net cost per QALY.84 Both measures assumed the service would be delivered to a US birth cohort over the years necessary for that service. Maciosek et al. found that smoking cessation advice and quit assistance was one of three services with the highest ranking on both measures.85 The other services were childhood immunisation and daily aspirin use for prevention of cardiovascular disease. Their analysis therefore strongly supports the prioritisation of smoking cessation programs, on economic efficiency and burden of disease grounds, over many other preventive services, including breast cancer screening, influenza immunisation for adults and cholesterol screening.
The Australian project, Assessing Cost-effectiveness in Prevention (ACE–Prevention) is similar in concept to this service-ranking framework, but it considered public health as well as clinical prevention strategies.2 To date, ACE–Prevention has analysed tobacco taxation and smoking cessation pharmacotherapies. Evaluations of other tobacco control interventions are underway. Findings in relation to tobacco taxation are detailed in Section 17.4. The three smoking cessation pharmacotherapies were classified by ACE-Prevention as 'very cost-effective preventive interventions'. All three medicines had cost-effectiveness ratios of $10 000 per DALY saved or less.
1. Kahende J, Loomis B, Adhikari B and Marshall L. A review of economic evaluations of tobacco control programs. International Journal of Environmental Research and Public Health. 2009;651–68. Available from: www.mdpi.com/1660-4601/6/1/51/pdf
2. Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman L, Magnus A, et al. Assessing Cost-Effectiveness in Prevention (ACE–Prevention) Final Report. Melbourne: Victorian Health Promotion Foundation, 2010. Available from: http://www.vichealth.vic.gov.au/~/media/About%20Us/Health%20promotion/ACE-Prevention_Sept2010_FINAL.ashx
3. Rogers T. The California Tobacco Control Program: introduction to the 20-year retrospective. Tobacco Control. 2010;19(Suppl 1):i1−i2. Available from: http://tobaccocontrol.bmj.com/content/19/Suppl_1/i1.short
4. Roeseler A and Burns D. The quarter that changed the world. Tobacco Control. 2010;19(Suppl 1):i3−i15. Available from: http://tobaccocontrol.bmj.com/content/19/Suppl_1/i3.abstract
5. Zhang X, Cowling DW and Tang H. The impact of social norm change strategies on smokers' quitting behaviours. Tobacco Control. 2010;19(Suppl 1):i51−5. Available from: http://tobaccocontrol.bmj.com/content/19/Suppl_1/i51.abstract
6. Miller LS, Max W, Sung H-Y, Rice D and Zaretsky M. Evaluation of the economic impact of California's Tobacco Control Program: a dynamic model approach. Tobacco Control. 2010;19(Suppl 1):i68−i76. Available from: http://tobaccocontrol.bmj.com/content/19/Suppl_1/i68.abstract http://tobaccocontrol.bmj.com/content/19/Suppl_1/i68.full.pdf
7. Applied Economics. Returns on investment in public health: An epidemiological and economic analysis Department of Health and Ageing, 2003. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/19B2B27E06797B79CA256F190004503C/$File/roi_eea.pdf
8. Hurley SF and Matthews JP. Cost-effectiveness of the Australian National Tobacco Campaign. Tobacco Control. 2008;17379–84. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/17/6/379
9. Control VCfT. Predicted impact of proposed tobacco control strategies. Melbourne: Cancer Council Victiria, 2009. Available from: http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/0FBE203C1C547A82CA257529000231BF/$File/commpaper-imp-tob-cont-strat.pdf
10. Collins D and Lapsley H. Counting the costs of tobacco and the benefits of reducing smoking prevalence in Western Australia. Monograph Series, No 4. Perth: The Cancer Council Western Australia, 2004.
11. Collins D and Lapsley H. Counting the costs of tobacco and the benefits of reducing smoking prevalence in New South Wales. Sydney: New South Wales Department of Health, 2005. Available from: http://www.health.nsw.gov.au/pubs/2005/smoking_reduction.html
12. Collins D and Lapsley H. Counting the costs of tobacco and the benefits of reducing smoking prevalence in Victoria. Victorian Department of Human Services, 2006. Available from: http://www.health.vic.gov.au/tobaccoreforms/social.htm
13. Farrelly M, Pechacek TF and Chaloupka F. The Impact of Tobacco Control Program Expenditures on Aggregate Cigarette Sales: 1981-1998. Journal of Health Economics. 2003
14. Tauras JA, Chaloupka FJ, Farrelly MC, Giovino GA, Wakefield M, Johnston LD, et al. State tobacco control spending and youth smoking. Am J Public Health. 2005;95(2):338-44. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15671473
15. Polednak A. Trends in death rates from tobacco-related cardiovascular diseases in selected US states differing in tobacco-control efforts. Epidemiology. 2009;20(4):542–46. Available from: http://journals.lww.com/epidem/pages/articleviewer.aspx?year=9000&issue=00000&article=99791&type=abstract
16. Lightwood JM, Dinno A and Glantz SA. Effect of the California tobacco control program on personal health care expenditures. PLoS Medicine. 2008;5(8):e178. Available from: http://medicine.plosjournals.org/archive/1549-1676/5/8/pdf/10.1371_journal.pmed.0050178-L.pdf
17. Hurley SF, Scollo MM, Younie SJ, English DR and Swanson MG. The potential for tobacco control to reduce PBS costs for smoking-related cardiovascular disease. Medical Journal of Australia. 2004;181(5):252–55. Available from: http://www.mja.com.au/public/issues/181_05_060904/hur10462_fm.pdf
18. Costello P. 2002–03 Budget Paper No. 5. Intergenerational report 2002–03, 2002. Commonwealth of Australia. Available from: http://www.budget.gov.au/2002-03/bp5/html/01_BP5Prelim.html
19. Hurley SF. The short-term impact of smoking cessation on myocardial infarction and stroke hospitalisations and costs in Australia. Medical Journal of Australia. 2005;183(1):13–17. Available from: http://www.mja.com.au/public/issues/183_01_040705/hur10832_fm.pdf
20. Lightwood JM and Glantz SA. Short-term economic and health benefits of smoking cessation. Circulation. 1997;96(4):1089–96.
21. Naidoo B, Stevens W and McPherson K. Modelling the short term consequences of smoking cessation in England on the hospitalisation rates for acute myocardial infarction and stroke. Tobacco Control. 2000;9397–400.
22. Hurley S, Matthews J and Guymer R. Cost-effectiveness of smoking cessation to prevent age-related macular degeneration. Cost Effective Resource Allocation. 2008;6(1):18. Available from: http://www.resource-allocation.com/content/pdf/1478-7547-6-18.pdf
23. Lightwood JM, Phibbs CS and Glantz SA. Short-term health and economic benefits of smoking cessation: low birth weight. Pediatrics. 1999;104(6):1312–20. Available from: http://pediatrics.aappublications.org/cgi/content/abstract/104/6/1312?ck=nck
24. Wakefield MA, Durkin S, Spittal MJ, Siahpush M, Scollo M, Simpson JA, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence. American Journal of Public Health. 2008;98(8):1443–50. Available from: http://www.ajph.org/cgi/content/abstract/98/8/1443
25. World Bank. Curbing the Epidemic: Governments and the Economics of Tobacco Control. Washington: World Bank, 1999. Available from: http://www1.worldbank.org/tobacco/
26. Gallet C and List J. Cigarette demand: a meta-analysis of elasticities. Health Economics. 2003;12(10):821–35. Available from: http://www3.interscience.wiley.com/journal/101520325/abstract?CRETRY=1&SRETRY=0
27. Ranson MK, Jha P, Chaloupka FJ and Nguyen SN. Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies. Nicotine and Tobacco Research. 2002;4(3):311–319. Available from: http://www.informaworld.com/smpp/content~db=all?content=10.1080/14622200210141000
28. IARC Handbooks of Cancer Prevention Tobacco Control. Evaluating the effectiveness of smokefree policies, Lyon, France: International Agency for Research on Cancer, 2009. Available from: http://com.iarc.fr/en/publications/pdfs-online/prev/handbook13/
29. Chapman S, Borland R, Scollo M, Brownson RC, Dominello A and Woodward S. The impact of smokefree workplaces on declining cigarette consumption in Australia and the United States. American Journal of Public Health. 1999;89(7):1018–23.
30. Fichtenberg C and Glantz S. Effect of smokefree workplaces on smoking behaviour: systematic review. British Medical Journal. 2002;325(7357): Available from: http://www.bmj.com/cgi/content/full/325/7357/188
31. US Department of Health and Human Services. Preventing tobacco use among young people: A report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr4304.pdf
32. Chaloupka F and Grossman M. Price, tobacco control policies and youth smoking. Cambridge MA National Bureau of Economic Research, 1996. Available from: http://www.impacteen.org/generalarea_PDFs/TERN_overheads0899.pdf
33. Chaloupka F and Wechsler H. Price, tobacco control policies and smoking among young adults. Journal of Health Economics. 1997;16(3):359-73. Available from: http://www.ingentaconnect.com/content/els/01676296/1997/00000016/00000003/art00530
34. Khuder SA, Milz S, Jordan T, Price J, Silvestri K and Butler P. The impact of a smoking ban on hospital admissions for coronary heart disease. Preventive Medicine. 2007;44. Available from: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17482249
35. Lightwood J and Glantz S. Declines in acute myocardial infarction after smokefree laws and individual risk attributable to secondhand smoke. Circulation. 2009;120(14):1373–9. Available from: http://circ.ahajournals.org/cgi/content/full/120/14/1373
36. Trachsel L, Kuhn M, Reinhart W, Schulzki T and Bonetti P. Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland. Swiss Medical Weekly. 2010;[Epub ahead oif print] Available from: http://www.smw.ch/docs/PdfContent/smw-12955.pdf
37. Villalbía JR, Castillob A, Cleriesc M, Saltóc E, Sánchezd E, Martíneze R, et al. Acute myocardial infarction hospitalization statistics: Apparent decline accompanying an increase in smokefree areas Revista Española de Cardiología. 2009;62(07):812–5. Available from: http://www.revespcardiol.org/cardio_eng/ctl_servlet?_f=60&ident=13140265
38. Ong MK and Glantz SA. Cardiovascular health and economic effects of smokefree workplaces. American Journal of Medicine. 2004;117(1):32-8. Available from: http://www.tobaccoscam.ucsf.edu/pdf/Ong-CV-Disease.pdf
39. Saffer H and Chaloupka F. Tobacco advertising: economic theory and international evidence working paper 6958. Cambridge: National Bureau of Economic Research, 1999.
40. Saffer H and Chaloupka F. The effect of tobacco advertising bans on tobacco consumption. Journal of Health Economics. 2000;19(6):1117–37.
41. Applied Economics. Cost-Benefit Analysis of Proposed New Health Warning on Tobacco Products. Commonwealth Department of Health and Ageing, 2003.
42. Winstanley M and Wood L. Chapter 5. Factors influencing the uptake and prevention of smoking. In: Scollo M, and Winstanley, M, ed. Tobacco in Australia: Facts and Issues, Melbourne: Quit Victoria, 2008. Available from: http://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-26-reducing-tobacco-access-and-supply
43. Purcell K. A National Approach for Reducing Access to Tobacco in Australia by Young People under 18 Years of Age. Canberra: Commonwealth of Australia, 2000. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/5BB6F2F38973D9F9CA256F190004A5B1/$File/minors_a.pdf
44. Tutt D, Bauer L and DiFranza J. Restricting the retail supply of tobacco to minors. Journal of Public Health Policy. 2009;30(1):68–82. Available from: http://www.palgrave-journals.com/jphp/journal/v30/n1/full/jphp200844a.html
45. White V, Warne C, Spittal M, Durkin S, Purcell K and Wakefield M. What impact have tobacco control policies, cigarette price and tobacco control program funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction 2011;106(8):1493-502. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03429.x/pdf
46. DiFranza JR, Peck RM, Radecki TE and Savageau JA. What is the potential cost-effectiveness of enforcing a prohibition on the sale of tobacco to minors? Preventive Medicine. 2001;32(2):168-74. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11162343
47. Stead LF and Lancaster T. Interventions for preventing tobacco sales to minors. Cochrane Database of Systematic Reviews.2005. (1) Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001497/frame.html
48. Centre for Behavioural Research in Cancer. Quit evaluation studies. Melbourne: Victorian Smoking and Health Program, 1985 to 2001. Available from: http://www.quit.org.au/browse.asp?ContainerID=1755
49. Pierce J, Dwyer T, Frape G, Chapman S, Chamberlain A and Burke N. Evaluation of the Sydney "Quit For Life" anti-smoking campaign. Part 1. Achievement of intermediate goals. The Medical Journal of Australia. 1986;144(7):341–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3959949
50. Pierce J, Macaskill A and Hill D. Long-term effectiveness of mass media led antismoking campaigns in Australia. American Journal of Public Health. 1990;80(5):565–9. Available from: http://www.ajph.org/cgi/content/abstract/80/5/565
51. Wakefield M, Freeman J and Boulter J. Changes associated with the National Tobacco Campaign. Pre and post campaign surveys compared. In: Hassard K, ed. Australia's National Tobacco Campaign. Evaluation Report Volume One. http://www.quitnow.info.au/internet/quitnow/publishing.nsf/content/D2D1DC8EA1C5CB8BCA257475001ADB96/$File/tobccamp1.pdf Canberra: Commonwealth Department of Health and Aged Care, 1999. 24–82.
52. Wakefield M, Freeman J and Donovan R. Recall and response of smokers and recent quitters to the Australian National Tobacco Campaign. Tobacco Control. 2003;12 (Suppl II):ii15–ii22. Available from: http://tc.bmjjournals.com/cgi/content/abstract/12/suppl_2/ii15
53. Wakefield M, Freeman J and Inglis G. Ch 5 Changes associated with the National Tobacco Campaign: Results of the third and fourth follow-up surveys. In: Hassard K, ed. Australia's National Tobacco Campaign, Evaluation Volume 3, Canberra: Department of Health and Ageing, 2004. Available from: http://www.quitnow.info.au/internet/quitnow/publishing.nsf/Content/evaluation-reports
54. Bala M, Strzeszynski L and Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev. 2008(1):CD004704. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18254058
55. National Cancer Institute. Part 4−Tobacco control and media interventions. In: The Role of the Media. Smoking and Tobacco Control Monograph No. 19, Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008. Available from: http://cancercontrol.cancer.gov/tcrb/monographs/19/index.html
56. Secker-Walker RH, Worden JK, Holland RR, Flynn BS and Detsky AS. A mass media programme to prevent smoking among adolescents: costs and cost effectiveness. Tobacco Control. 1997;6(3):207–12. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1759579&blobtype=pdf
57. Ratcliffe J, Cairns J and Platt S. Cost effectiveness of a mass media-led anti-smoking campaign in Scotland. Tobacco Control. 1997;6(2):104–10. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/6/2/104
58. Stead LF, Perera R and Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews.2006. (3) Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002850/frame.html
59. Stead LF, Perera R and Lancaster T. A systematic review of interventions for smokers who contact quitlines. Tobacco Control. 2007;16(Suppl 1):i3–8. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/16/Suppl_1/i3
60. McAlister AL, Rabius V, Geiger A, Glynn TJ, Huang P and Todd R. Telephone assistance for smoking cessation: one year cost effectiveness estimations. Tobacco Control. 2004;1385–6.
61. Tomson T, Helgason AR and Gilljam H. Quitline in smoking cessation: a cost-effectiveness analysis. International journal of Technology Assessment in Health Care. 2004;20(4):469–74. Available from: PM:15609797
62. Cummings KM, Hyland A, Fix B, Bauer U, Celestino P, Carlin-Menter S, et al. Free nicotine patch giveaway program 12-month follow-up of participants. American Jounal of Preventive Medicine. 2006;31(2):181–4. Available from: PM:16829336
63. Fellows JL, Bush T, McAfee T and Dickerson J. Cost effectiveness of the Oregon quitline "free patch initiative". Tobacco Control. 2007;16(Suppl_1):i47-52. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/16/Suppl_1/i47
64. Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M and Riedlinger K. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control. 2007;16(Suppl 1):i53−9. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/16/Suppl_1/i53
65. Stead LF and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews.2005. (2) Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001007/frame.html
66. Bock B, Graham A, Whiteley J and Stoddard J. A review of web-assisted tobacco interventions (WATIs). Journal of Medical Internet Research. 2008;10(5):e39. Available from: http://www.jmir.org/2008/5/e39/
67. Whittaker R, Borland R, Bullen C, Lin R, McRobbie H and Rodgers A. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2009(4): Available from: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006611/pdf_fs.html
68. Stead LF, Bergson G and Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008(2):CD000165. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18425860
69. Brown AD and Garber AM. Cost effectiveness of coronary heart disease prevention strategies in adults. Pharmacoeconomics. 1998;14(1):27-48. Available from: http://www.ingentaconnect.com/content/adis/pec/1998/00000014/00000001/art00004
70. Sinclair HK, Bond CM and Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews.2004. (1) Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003698/frame.html
71. Gorin SS and Heck JE. Meta-analysis of the efficacy of tobacco counseling by health care providers. Cancer Epidemiology, Biomarkers & Prevention. 2004;13(12):2012–22. Available from: http://cebp.aacrjournals.org/cgi/content/abcostract/13/12/2012
72. Rigotti NA, Munafo MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane.Database.Syst.Rev. 2008(4):CD001837.
73. Rice VH and Stead LF. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews.2008. (1) Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001188/frame.html
74. Cantrell J and Shelley D. Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study. BMC Family Practice. 2009;1081. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811101/?tool=pubmed
75. Borland R, Balmford J, Bishop N, Segan C, Piterman L, McKay-Brown L, et al. In-practice management versus quitline referral for enhancing smoking cessation in general practice: a cluster randomized trial. Family practice 2008;25(5):382-9. Available from: http://fampra.oxfordjournals.org/cgi/content/full/cmn046v1
76. Zwar N, Richmond R, Borland R, Stillman S, Cunningham M and Litt J. Smoking Cessation Guidelines for Australian General Practice. Practice Handbook 2004 Edition. Canberra: Royal Australian College of General Practitioners, 2004. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/6F8B2F83E439599BCA256F1900045114/$File/smoking_cessation.pdf
77. Pharmaceutical Benefits Advisory C. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (Version 4.2). December 2007: Checklists and Tables. Department of Health and Ageing, Commonwealth of Australia, 2007. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/AECB791C29482920CA25724400188EDB/$File/PBAC4.3.2(01DEC08).pdf
78. Australian Government DoHaA. March 2010 PBAC meeting outcomes - Positive recommendations, 2010. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/727FC28848C6C4C1CA2577070001FA13/$File/PBAC%20Positive%20Outcomes%20032010.pdf
79. Bertram MY, Lim SS, Wallace AL and Vos T. Costs and benefits of smoking cessation aids: making a case for public reimbursement of nicotine replacement therapy in Australia. Tobacco Control. 2007;16(4):255–60.
80. Perez DCT, Makino K, Bhatti T, Gordois A, Guarnieri C, Lewis S, et al. Pharmacotherapy Evaluation. Drugs that assist smoking cessation. October 2008. NSW: Cancer Institute NSW, 2008.
81. Shearer J and Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Australian and New Zealand Journal of Public Health. 2006;30(5):428–34.
82. Aubin HJ, Bobak A, Britton JR, Oncken C, Billing CB, Jr., Gong J, et al. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax. 2008;63(8):717–24. Available from: http://thorax.bmj.com/cgi/rapidpdf/thx.2007.090647v1
83. Consortium of not-for-profit organisations. Submission to the PBAC: Proposed extension of nicotine patch listing. Executive summary. Melbourne, 2009. Available from: http://www.vctc.org.au/downloads/Nicotine_patch_listing.pdf
84. Maciosek MV, Edwards NM, Coffield AB, Flottemesch TJ, Nelson WW, Goodman MJ, et al. Priorities among effective clinical preventive services: methods. American Journal of Preventive Medicine. 2006;31(1):90-6. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16777547
85. Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ and Solberg LI. Prioritizing Clinical Preventive Services: A Review and Framework with Implications for Community Preventive Services. Annual Review of Public Health. 2009;30(1):341-55. Available from: http://arjournals.annualreviews.org/doi/abs/10.1146/annurev.publhealth.031308.100253
Cohen, D., M. Alam, and P. Jarvis, An analysis of the economic impact of
smoking cessation in Europe. BMC Public Health, 2013. 13: p. 390.Available from: http://www.biomedcentral.com/1471-2458/13/390
Sanders, A., G. Slade, L. Ranney, L. Jones, and A. Goldstein, Valuation of tobacco control policies by the public in North Carolina: comparing perceived benefit with projected cost of implementation. North Carolina Medical Journal, 2012. 73(6): p. 439-47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23617155
Laura M Currie, Kenneth Blackman, Luke Clancy, David T Levy. The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths in Ireland using the IrelandSS simulation model Tob Control 2013; 22 e25-e32 http://tobaccocontrol.bmj.com/cgi/content/abstract/22/e1/e25?etoc