Cost‐effectiveness of tobacco control policies in Vietnam: the case of personal smoking cessation support

Abstract

To examine the cost-effectiveness of personal smoking cessation support in Vietnam. We followed-up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost-effective. A multi-state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health-care perspective was employed. Cost-effectiveness is measured in 2006 Vietnamese Dong (VND) per disability-adjusted life year (DALY) averted. We adopted the World Health Organization thresholds of being 'cost-effective' if less than three times gross domestic product (GDP) per capita (VND 34,600,000) and 'very cost-effective' if less than GDP per capita (VND 11,500,000). The cost-effectiveness result of physician brief advice was VND 1,742,000 per DALY averted (international dollars 543), which was 'very cost-effective'. Varenicline dominated bupropion and nicotine-replacement therapies, although it did not fall within the range of being 'cost-effective' under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost-effective in Vietnam. Physician brief advice is a cost-effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost-effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.