Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.
Centro de Investigação em Saúde Pública, Lisboa, Portugal.
Nicotine Tob Res. 2020 Jun 12;22(7):1202-1209. doi: 10.1093/ntr/ntz124.
Economic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal.
Cost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%-50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness.
Nonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity.
All five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates.
Economic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.
针对青少年的控烟政策的经济评估较为匮乏。很少有研究考虑到现实世界中大规模实施的成本；很少有研究比较不同国家不同政策的成本效益。我们评估了五项控烟政策（非学校禁烟，包括禁止向未成年人售烟、公共场所禁烟、销售点广告禁令、学校无烟禁令和学校教育计划）的成本效益，这些政策于 2016 年在芬兰、爱尔兰、荷兰、比利时、德国、意大利和葡萄牙实施。
从国家角度，按政策和国家对成本效益进行评估。成本是通过结合针对每个环境下政策实施情况的定量问卷和半结构化访谈收集的，是实际实践中的成本。短期效果基于文献，长期效果使用 DYNAMO-HIA 工具进行建模。对成本和效果使用 3.5%的折扣率。敏感性分析考虑了 1%-50%的短期效果估计值、最高成本估计值和未贴现效果。
非学校禁烟政策的健康生命年成本最高可达 253.23 欧元，学校禁烟政策的健康生命年成本最高可达 91.87 欧元，学校教育计划的健康生命年成本最高可达 481.35 欧元。成本效益取决于实施成本、短期效果、初始吸烟率、目标人群的规模以及吸烟在总死亡率和发病率中的权重。
根据世界卫生组织公共卫生干预措施的阈值，所有五项政策在所有国家都具有高度成本效益。即使使用最高成本和最保守的效果估计值，成本效益也得以保留。
使用大规模实施的控烟政策的实际数据进行经济评估较为匮乏，特别是针对青少年的非学校禁烟政策。我们评估了 2016 年在芬兰、爱尔兰、荷兰、比利时、德国、意大利和葡萄牙实施的五项控烟政策的成本效益。本研究表明，考虑到世界卫生组织的阈值，所有五项政策都具有高度的成本效益，即使考虑到最高成本和最保守的效果估计值。
