Cost effectiveness of tobacco control policies in Vietnam
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Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries.
The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam.
Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis.
All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. <GDP per capita). Graphic warning labels on cigarette packs was the most cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector.
All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.
KeywordsTobacco Control Smoking Prevalence Health Gain Cessation Rate Lower Respiratory Tract Infection
This research was supported by the Atlantic Philanthropies under the ‘Developing the Evidence Base for Health Policy in Vietnam’ project. The agency had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript.
The authors would like to extend their highest appreciation to the individuals from the School of Population Health, The University of Queensland, including Dr Coral E. Gartner for her significant advice on tobacco issues and prevalence modelling, and Associate Professor Peter S. Hill and Dr Anh D. Ngo for their extended support in facilitating the study. Jan J. Barendregt owns EpiGear, which sells the Ersatz software used in the analysis.
- 1.WHO. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: WHO, 2008Google Scholar
- 2.General Statistics Office. Vietnam living standard survey (VLSS), 1992–1993. Hanoi: General Statistics Office, 1994Google Scholar
- 3.General Statistics Office. Vietnam living standard survey (VLSS), 1997–1998. Hanoi: General Statistics Office, 2000Google Scholar
- 4.Ministry of Health, Vietnam. National health survey, 2001–02. Hanoi: MOH, 2003Google Scholar
- 5.Ly NK, Nguyen NK, Dang HH, et al. An overview of tobacco use and control in Vietnam. J Pract Med 2006; 533: 5–17Google Scholar
- 6.Southeast Asia Tobacco Control Alliance. Status of tobacco use and its control: Vietnam report card. Bangkok: SEATCA, 2008Google Scholar
- 7.Government of Vietnam. National tobacco control policy 2000–2010. Hanoi: Government of Vietnam, 2000Google Scholar
- 8.Vietnam Evidence for Health Policy (VINE) project. Developing the evidence base for health policy in Vietnam. Brisbane and Hanoi: School of Population Health, The University of Queensland, Health Strategy and Policy Institute, Ministry of Health, Vietnam, 2006Google Scholar
- 9.Vietnam Evidence for Health Policy (VINE) project. Vietnam burden of disease and injury study 2008. Brisbane and Hanoi: School of Population Health, The University of Queensland, Hanoi School of Public Health, Ministry of Health, Vietnam, 2011Google Scholar
- 11.The Central Data Processing Centre. Data and results from the 3% sample of the population and housing census 1/4/1999. Hanoi: The Central Data Processing Centre, 2000Google Scholar
- 12.General Statistics Office. Result of the Vietnam household living standards survey 2006. Hanoi: General Statistics Office, 2007Google Scholar
- 13.General Statistics Office. The 2006 population change, labour force and family planning survey. Hanoi: General Statistics Office, 2007Google Scholar
- 14.WHO. Health statistics and health information systems: life tables for WHO member states. 2006 [online]. Available from URL: http://apps.who.int/whosis/database/life_tables/life_tables.cfm [Accessed 2008 Sep 29]
- 15.Bundhamcharoen K, Teerawatananon Y, Vos T, et al. Burden of disease and injuries in Thailand, 1999. Nonthabury: Bureau of Health Policy and Planning, Ministry of Public Health, 2002Google Scholar
- 16.Ezzati M, Lopez AD, Rodgers A, et al., editors. Comparative quantification of health risks. Geneva: WHO, 2004Google Scholar
- 22.Stouthard MEA, Essink-Bot ML, Bonsel GJ, et al. Disability weights for diseases in the Netherlands. Rotterdam: Erasmus University, 1997Google Scholar
- 23.Edejer TTT, Baltussen R, Adam T, et al. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: WHO, 2003Google Scholar
- 27.Framework Convention Alliance. How big was the global illicit tobacco trade problem in 2006? [factsheet]. Geneva: FCA, 2008Google Scholar
- 34.Patten CA, Gilpin E, Cavin SW, et al. Workplace smoking policy and changes in smoking behaviour in California: a suggested association. BMJ 1995; 4(1): 36–41Google Scholar
- 36.Esson KM, Leeder SR. The Millennium Development Goals and tobacco control: an opportunity for global partnership. Geneva: WHO, 2004Google Scholar
- 37.Epigear. Ersatz 1.0. Brisbane (QLD): Epigear International PTY LTD, 2009Google Scholar
- 38.Veerman J, Mackenbach J, Barendregt J. Validity of predictions in health impact assessment. Br Med J 2007; 61(4): 362Google Scholar
- 40.Heston A, Summers R, Aten B. Penn world table version 6.3. 2009 [online]. Available from URL: http://pwt.econ.upenn.edu/php_site/pwt63/pwt63_form.php [Accessed 2009 Apr 29]
- 42.International Monetary Fund. World economic outlook database. 2006 [online]. Available from URL: http://www.imf.org/external/pubs/ft/weo/2009/01/weodata/weorept.aspx?sy=2006&ey=2007&scsm=1&ssd=1&sort=country&ds=.&br=1&c=582&s=NGDPPC&grp=0&a=&pr.x=88&pr.y=12 [Accessed 2009 Apr 12]Google Scholar
- 44.Jha P, Chaloupka FJ. Tobacco control in developing countries. Oxford: Oxford University Press, 2000Google Scholar
- 52.US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989Google Scholar
- 54.Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2005Google Scholar