Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States of America.
JPMorgan Chase & Co., San Francisco, California, United States of America.
PLoS One. 2023 Mar 16;18(3):e0263579. doi: 10.1371/journal.pone.0263579. eCollection 2023.
Previous research used data through 2008 to estimate a model for the effect of the California Tobacco Control Program (CTCP) that used cumulative real per capita tobacco control expenditure to predict smoking behavior (current adult smoking prevalence and mean cigarette consumption per current smoker). Predicted changes in smoking behavior due to the CTCP were used to predict its effect on health care expenditure. This research updates the model using the most recently available data and estimates CTCP program effect through 2019.
The data used in the previous research were updated, and the original model specification and a related predictive forecast model were re-estimated. The updated regression estimates were compared to those previously published and used to update estimates of CTCP program effect in 2019 dollars.
There was no evidence of structural change in the previously estimated model. The estimated effect of the CTCP program expenditures on adult current smoking prevalence and mean consumption per adult current smoker has remained stable over time. Over the life of the program, one additional dollar per capita of program expenditure was associated with a reduction of current adult smoking prevalence by about 0.05 percentage point and mean annual consumption per adult current smoker by about 2 packs. Using updated estimates, the program prevented 9.45 (SE 1.04) million person-years of smoking and cumulative consumption of 15.7 (SE 3.04) billion packs of cigarettes from 1989 to 2019. The program produced cumulative savings in real healthcare expenditure of $544 (SE $82) billion using the National Income and Product Accounts (NIPA), and $816 (SE $121) billion using the Center for Medicare and Medicaid Services (CMS) measure of medical costs. During this time, the CTCP expenditure was $3.5 billion.
A simple predictive model of the effectiveness of the CTCP program remained stable and retains its predictive performance out-of-sample. The updated estimates of program effect suggest that CTCP program has retained its effectiveness over its 31-year life and produced a return on investment of 231 to 1 in direct CMS medical expenditure.
先前的研究使用截至 2008 年的数据来估计加利福尼亚州烟草控制计划（CTCP）的效果模型，该模型使用累计实际人均烟草控制支出来预测吸烟行为（当前成年吸烟率和当前吸烟者平均吸烟量）。由于 CTCP 而预测的吸烟行为变化用于预测其对医疗保健支出的影响。本研究使用最新可用数据更新了该模型，并估计了截至 2019 年 CTCP 计划的效果。
更新了先前研究中使用的数据，并重新估计了原始模型规范和相关预测模型。比较了更新的回归估计值和先前发表的值，并用于更新 2019 年美元的 CTCP 计划效果估计值。
先前估计的模型没有结构变化的证据。CTCP 计划支出对当前成年吸烟率和当前成年吸烟者平均消费的影响在一段时间内保持稳定。在计划的生命周期内，人均计划支出增加 1 美元，与当前成年吸烟者的吸烟率降低约 0.05 个百分点和成年吸烟者平均每年消费的香烟减少 2 包有关。使用更新的估计值，该计划从 1989 年到 2019 年预防了 945 万人-年的吸烟和 157 亿包香烟的累计消费。该计划通过使用国民收入和产品账户（NIPA）产生了 5440 亿美元（SE 820 亿美元）的实际医疗保健支出累计储蓄，通过使用医疗保险和医疗补助服务中心（CMS）的医疗成本衡量标准产生了 8160 亿美元（SE 1210 亿美元）的储蓄。在此期间，CTCP 支出为 35 亿美元。
CTCP 计划有效性的简单预测模型保持稳定，并保持其样本外的预测性能。更新后的计划效果估计表明，CTCP 计划在其 31 年的生命周期内保持了有效性，并在直接 CMS 医疗支出方面实现了 231 比 1 的投资回报。
