7.6 Cost-effectiveness analysis of smoking interventions
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There are two broad aspects to the question of costs and effectiveness of smoking interventions at the population level:
- The cost-effectiveness analysis of smoking cessation compared to other public health or medical interventions.
- The cost-effectiveness analysis of different approaches or levels of intensity to smoking cessation.
Both aspects are complex to estimate and information is scarce for Australia. The value of smoking cessation in comparison to other health interventions is clearly demonstrated in studies from around the world that can be extrapolated to Australia. Interventions that promote cessation of smoking typically cost between hundreds of dollars and several thousand dollars per life year saved, while other medical interventions more typically cost tens of thousands of dollars, making smoking cessation therapies one of the most cost-effective health interventions.58 In Australia, consulting firm Applied Economics prepared a report for the Commonwealth Department of Health and Ageing in 2003 that compared public health programs to reduce tobacco consumption, coronary heart disease, HIV/AIDS, measles and Hib-related diseases, and road trauma. For tobacco, it was concluded that for government, there was a saving of $2 for every $1 spent on tobacco control campaigns. Based on very conservative assumptions (e.g. that Quit Campaigns were responsible for only 10% of the reduction in tobacco use) the estimated present value of overall social benefits was $8.6 billion, compared to costs of $176 million.59
The cost-effectiveness of differing approaches to smoking cessation has never been estimated for Australia, but overseas research suggests the costs per life year saved vary from a few hundred dollars for media campaigns to several thousand dollars for intensive interventions by health workers.60 The actual values depend on success rates and smoker characteristics. Since more intense interventions are more often used by more dependent smokers and those with other problems that make quitting harder, these estimates may overestimate the costs of more intensive approaches were they to be used by ordinary smokers.61
Another issue is whether children rather than adults should be the target for intervention.
There are several reasons for a broader focus, rather than concentrating on smoking prevention. School-based educational programs have generally proved to be ineffective,62 however children are positively affected by campaigns aimed at the whole community.63 Smoking cessation campaigns can reduce smoking among young people, by direct influence through exposure to the campaign, and by indirect influence through parents quitting64–66 and through the effects of making the home smokefree.67–69 In addition, a focus on cessation will bring much faster returns. Mortality from tobacco use over the next 50 years will be affected much more by the number of adults who quit than by the number of adolescents who start.26
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