Cost effectiveness of tobacco control policies in Vietnam

The case of population-level interventions
  • Hideki HigashiEmail author
  • Khoa D. Truong
  • Jan J. Barendregt
  • Phuong K. Nguyen
  • Mai L. Vuong
  • Thuy T. Nguyen
  • Phuong T. Hoang
  • Angela L. Wallace
  • Tien V. Tran
  • Cuong Q. Le
  • Christopher M. Doran
Original Research Article



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.


Tobacco Control Smoking Prevalence Health Gain Cessation Rate Lower Respiratory Tract Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

40258_2012_90301831_MOESM1_ESM.pdf (277 kb)
Supplementary material, approximately 284 KB.


  1. 1.
    WHO. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: WHO, 2008Google Scholar
  2. 2.
    General Statistics Office. Vietnam living standard survey (VLSS), 1992–1993. Hanoi: General Statistics Office, 1994Google Scholar
  3. 3.
    General Statistics Office. Vietnam living standard survey (VLSS), 1997–1998. Hanoi: General Statistics Office, 2000Google Scholar
  4. 4.
    Ministry of Health, Vietnam. National health survey, 2001–02. Hanoi: MOH, 2003Google Scholar
  5. 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. 6.
    Southeast Asia Tobacco Control Alliance. Status of tobacco use and its control: Vietnam report card. Bangkok: SEATCA, 2008Google Scholar
  7. 7.
    Government of Vietnam. National tobacco control policy 2000–2010. Hanoi: Government of Vietnam, 2000Google Scholar
  8. 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. 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
  10. 10.
    Gartner CE, Barendregt JJ, Hall WD. Predicting the future prevalence of cigarette smoking in Australia: how low can we go and by when? Tob Control 2009; 18(3): 183–9PubMedCrossRefGoogle Scholar
  11. 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. 12.
    General Statistics Office. Result of the Vietnam household living standards survey 2006. Hanoi: General Statistics Office, 2007Google Scholar
  13. 13.
    General Statistics Office. The 2006 population change, labour force and family planning survey. Hanoi: General Statistics Office, 2007Google Scholar
  14. 14.
    WHO. Health statistics and health information systems: life tables for WHO member states. 2006 [online]. Available from URL: [Accessed 2008 Sep 29]
  15. 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. 16.
    Ezzati M, Lopez AD, Rodgers A, et al., editors. Comparative quantification of health risks. Geneva: WHO, 2004Google Scholar
  17. 17.
    Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. JAMA 2000; 284(6): 706–12PubMedCrossRefGoogle Scholar
  18. 18.
    Ezzati M, Henley SJ, Lopez AD, et al. Role of smoking in global and regional cancer epidemiology: current patterns and data needs. Int J Cancer 2005; 116(6): 963–71PubMedCrossRefGoogle Scholar
  19. 19.
    Ezzati M, Henley SJ, Thun MJ, et al. Role of smoking in global and regional cardiovascular mortality. Circulation 2005; 112(4): 489–97PubMedCrossRefGoogle Scholar
  20. 20.
    Barendregt JJ, Van Oortmarssen GJ, Van Hout BA, et al. Coping with multiple morbidity in a life table. Math Popul Stud 1998; 7(1): 29–49PubMedCrossRefGoogle Scholar
  21. 21.
    Barendregt JJ, Van Oortmarssen GJ, Vos T, et al. A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metr 2003; 1(1): 4PubMedCrossRefGoogle Scholar
  22. 22.
    Stouthard MEA, Essink-Bot ML, Bonsel GJ, et al. Disability weights for diseases in the Netherlands. Rotterdam: Erasmus University, 1997Google Scholar
  23. 23.
    Edejer TTT, Baltussen R, Adam T, et al. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: WHO, 2003Google Scholar
  24. 24.
    Brown AM. A step-by-step guide to non-linear regression analysis of experimental data using a Microsoft Excel spreadsheet. Comput Methods Programs Biomed 2001; 65(3): 191–200PubMedCrossRefGoogle Scholar
  25. 25.
    Van Kinh H, Ross H, Levy D, et al. The effect of imposing a higher, uniform tobacco tax in Vietnam. Health Res Policy Syst 2006 Jun 26; 4(1): 6CrossRefGoogle Scholar
  26. 26.
    Laxminarayan R, Deolalikar A. Tobacco initiation, cessation, and change: evidence from Vietnam. Health Econ 2004; 13(12): 1191–201PubMedCrossRefGoogle Scholar
  27. 27.
    Framework Convention Alliance. How big was the global illicit tobacco trade problem in 2006? [factsheet]. Geneva: FCA, 2008Google Scholar
  28. 28.
    Hammond D, McDonald PW, Fong GT, et al. The impact of cigarette warning labels and smoke-free bylaws on smoking cessation. Can J Public Health 2004; 95(3): 201–4PubMedGoogle Scholar
  29. 29.
    Levy DT, Bales S, Lam NT, et al. The role of public policies in reducing smoking and deaths caused by smoking in Vietnam: results from the Vietnam tobacco policy simulation model. Soc Sci Med 2006; 62(7): 1819–30PubMedCrossRefGoogle Scholar
  30. 30.
    Hafstad A, Aaro LE, Engeland A, et al. Provocative appeals in anti-smoking mass media campaigns targeting adolescents: the accumulated effect of multiple exposures. Health Educ Res 1997 Jun 1; 12(2): 227–36PubMedCrossRefGoogle Scholar
  31. 31.
    Jenkins CN, McPhee SJ, Le A, et al. The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men. Am J Public Health 1997; 87(6): 1031–4PubMedCrossRefGoogle Scholar
  32. 32.
    Wakefield MA, Chaloupka FJ, Kaufman NJ, et al. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. BMJ 2000; 321(7257): 333–7PubMedCrossRefGoogle Scholar
  33. 33.
    Longo DR, Johnson JC, Kruse RL, et al. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tob Control 2001 Sep 1; 10(3): 267–72PubMedCrossRefGoogle Scholar
  34. 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
  35. 35.
    Ross H, Trung DV, Phu VX. The costs of smoking in Vietnam: the case of inpatient care. Tob Control 2007; 16(6): 405–9PubMedCrossRefGoogle Scholar
  36. 36.
    Esson KM, Leeder SR. The Millennium Development Goals and tobacco control: an opportunity for global partnership. Geneva: WHO, 2004Google Scholar
  37. 37.
    Epigear. Ersatz 1.0. Brisbane (QLD): Epigear International PTY LTD, 2009Google Scholar
  38. 38.
    Veerman J, Mackenbach J, Barendregt J. Validity of predictions in health impact assessment. Br Med J 2007; 61(4): 362Google Scholar
  39. 39.
    Mendez D, Warner KE, Courant PN. Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States. Am J Epidemiol 1998; 148(3): 249–58PubMedCrossRefGoogle Scholar
  40. 40.
    Heston A, Summers R, Aten B. Penn world table version 6.3. 2009 [online]. Available from URL: [Accessed 2009 Apr 29]
  41. 41.
    Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc 2003; 1(1): 8PubMedCrossRefGoogle Scholar
  42. 42.
    International Monetary Fund. World economic outlook database. 2006 [online]. Available from URL: [Accessed 2009 Apr 12]Google Scholar
  43. 43.
    Ranson MK, Jha P, Chaloupka FJ, et al. Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies. Nicotine Tob Res 2002; 4(3): 311–9PubMedCrossRefGoogle Scholar
  44. 44.
    Jha P, Chaloupka FJ. Tobacco control in developing countries. Oxford: Oxford University Press, 2000Google Scholar
  45. 45.
    Peto R, Boreham J, Lopez AD, et al. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992; 339(8804): 1268–78PubMedCrossRefGoogle Scholar
  46. 46.
    Chen ZM, Xu Z, Collins R, et al. Early health effects of the emerging tobacco epidemic in China: a 16-year prospective study. JAMA 1997 Nov 12; 278(18): 1500–4PubMedCrossRefGoogle Scholar
  47. 47.
    Gu D, Kelly TN, Wu X, et al. Mortality attributable to smoking in China. N Engl J Med 2009 Jan 8; 360(2): 150–9PubMedCrossRefGoogle Scholar
  48. 48.
    Niu SR, Yang GH, Chen ZM, et al. Emerging tobacco hazards in China: 2. Early mortality results from a prospective study. BMJ 1998 Nov 21; 317(7170): 1423–4PubMedCrossRefGoogle Scholar
  49. 49.
    Peto R, Chen ZM, Boreham J. Tobacco: the growing epidemic in China. CVD Prevent Control 2009; 4 (1): 61–70CrossRefGoogle Scholar
  50. 50.
    Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control 1994; 3(3): 242–7CrossRefGoogle Scholar
  51. 51.
    Lam TH, He Y, Li LS, et al. Mortality attributable to cigarette smoking in China. JAMA 1997 Nov 12; 278(18): 1505–8PubMedCrossRefGoogle Scholar
  52. 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
  53. 53.
    Barendregt JJ, Bonneux L, van der Maas PJ. The health care costs of smoking. N Engl J Med 1997 Oct 9; 337(15): 1052–7PubMedCrossRefGoogle Scholar
  54. 54.
    Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2005Google Scholar
  55. 55.
    Carter R, Vos T, Moodie M, et al. Priority setting in health: origins, description and application of the Australian Assessing Cost Effectiveness initiative. Exp Rev Pharmacoeconomics Outcomes Res 2008; 8(6): 593–617CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Hideki Higashi
    • 1
    • 6
    Email author
  • Khoa D. Truong
    • 2
    • 3
  • Jan J. Barendregt
    • 1
  • Phuong K. Nguyen
    • 2
  • Mai L. Vuong
    • 2
  • Thuy T. Nguyen
    • 2
  • Phuong T. Hoang
    • 2
  • Angela L. Wallace
    • 1
  • Tien V. Tran
    • 2
  • Cuong Q. Le
    • 2
  • Christopher M. Doran
    • 4
    • 5
  1. 1.School of Population HealthThe University of QueenslandBrisbaneAustralia
  2. 2.Health Strategy and Policy InstituteHanoiVietnam
  3. 3.Department of Public Health SciencesClemson UniversityClemsonUSA
  4. 4.National Drug and Alcohol Research CentreThe University of New South WalesSydneyAustralia
  5. 5.Hunter Medical Research InstituteNewcastleAustralia
  6. 6.School of Population HealthThe University of QueenslandHerstonAustralia

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