A cost-effectiveness analysis of India's 2008 prohibition of smoking in public places in Gujarat.

Elisabeth A Donaldson,Bhavesh Modi,Monika Arora,Paresh Dave,Hugh R Waters,Beena Varghese

doi:10.3390/ijerph8051271

Abstract

Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India’s Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.

Highlights

Tobacco use constitutes a global epidemic that results in five million deaths each year [1]
Through implementation of a complete smoking ban as compared to the current partial ban contained in current Cigarettes and Other Tobacco Products Act (COTPA) legislation, 17,000 additional cases of acute myocardial infarction (AMI) could be averted in Gujarat
Based on the decision analytic model, implementing a complete smoking ban covering all public places is cost saving compared to the current COTPA legislation and 2008 Rules when the incremental cost-effectiveness ratio (ICER) is calculated with natural units, as well as with the summary measure of life years (LYs)

Summary

Introduction

Tobacco use constitutes a global epidemic that results in five million deaths each year [1]. If current trends in tobacco use continue, the number of tobacco-related deaths is expected to rise to eight million deaths annually by 2030—with 80 percent of these deaths ocurring in low- and middle-income countries (LMICs) [2]. Tobacco Survey, a nationally representative household survey, found that 34.6% of adults over the age of 15 in India currently use tobacco [3]. Most smokers in India consume bidis, small cigarettes containing, on average, 25 percent less tobacco than the average manufactured cigarette [4]. One nationally representative case-control study found that about 70% of smoking-related deaths in India take place during productive years of life between 30–69 years of age [4].

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