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Smoking, health-related quality of life and economic evaluation

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Abstract

Background and aims

The economic evaluation of tobacco control policies requires the adoption of assumptions about the impact of changes in smoking status on health-related quality of life (HRQoL). Estimates for such impacts are necessary for different populations. This paper aims to test whether smoking status has an independent effect on HRQoL over and above the effect derived from the increased likelihood of suffering a tobacco related disease, and to calculate utility values for the Spanish population.

Methods

Using data from the Spanish Encuesta Nacional de Salud of 2011–12, we estimate statistical models for HRQoL as measured by the EQ-5D-5L instrument as a function of smoking status. We include a comprehensive set of controls for biological, clinical, lifestyle and socioeconomic characteristics.

Results

Smoking status has an independent, statistically significant effect on HRQoL. However, the size of the effect is small. The typical smoking related diseases, such as lung cancer, are associated with a reduction in HRQoL about 5 times larger than the difference between current smokers and never smokers.

Conclusion

Attributing substantive HRQoL gains to quitting smoking as well as accounting for the concomitant HRQoL gain derived from a smaller likelihood of contracting tobacco related diseases might lead to an overestimation of the benefits of tobacco control policies. Nonetheless, the relatively large drops in HRQoL associated with being diagnosed with diseases that might be causally linked to tobacco suggest that such diseases should not be omitted from the economic evaluations of tobacco control policies.

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Notes

  1. The Short Form-36 (SF-36) questionnaire is an established and also widely used health-related quality of life measure (HRQoL) [19]. It comprises eight health domains including ‘physical functioning’ [19].

  2. The estimation of the second part of the model uses a smaller number of observations than the estimation for the first part. As reflected in Table 1, the sample sizes are 2770 for men and 5117 for women. However, these samples contain variation in smoking status: among males there are 952 never smokers, 796 current smokers and 1022 former smokers and among women the corresponding figures are 3729, 845 and 543.

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Acknowledgements

The authors are very grateful to Dr. Toni Mora for his invaluable help and support to finish this paper. This work was partially funded by the European Union’s FP7 programme (the EQUIPT Project; Grant agreement 602270) and partially by the Spanish Ministry of Economy and Competitiveness (MINECO) under the programme “Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad, Plan Estatal de Investigación Científica Técnica y de Innovación 2013–2016”. Grant ECO2013-48217-C2-1 (http://invesfeps.ulpgc.es/en). The funders had no influence on the conduction of this study or the drafting of this manuscript. We are grateful for the comments and suggestions of the editor of this journal and two anonymous referees. The usual disclaimer applies.

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Authors and Affiliations

  1. Economics Department, Faculty of Business Science, Universidad Politécnica de Cartagena (UPCT), C/Real, 3, 30201, Cartagena (Murcia), Spain

    Ángel López-Nicolás

  2. Faculty of Economic and Social Sciences, Universitat Internacional de Catalunya (UIC), C/Immaculada, 22, 08017, Barcelona, Spain

    Marta Trapero-Bertran

  3. Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Marta Trapero-Bertran & Celia Muñoz

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  1. Ángel López-Nicolás
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Correspondence to Ángel López-Nicolás.

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López-Nicolás, Á., Trapero-Bertran, M. & Muñoz, C. Smoking, health-related quality of life and economic evaluation. Eur J Health Econ 19, 747–756 (2018). https://doi.org/10.1007/s10198-017-0919-1

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