The effectiveness and cost-effectiveness of price increases and other tobacco- control policies

This chapter provides conservative estimates of the effectiveness and cost-effectiveness of tobacco-control policies. Using a model of the cohort of smokers alive in 1995, we find that tax increases that would raise the real price of cigarettes by 10% worldwide would cause about 42 million of these smokers to quit. This price increase would prevent a minimum of 10 million tobacco-related deaths. A combined set of non-price measures (such as comprehensive bans on advertising and promotion, bans on smoking in public places, prominent warning labels, and mass information) would cause some 23 million smokers alive in 1995 to quit and would prevent 5 million deaths. The non-price measures are assumed to have an effectiveness of 2%—a conservative assumption. Increased use of nicotine-replacement therapies (NRTs), with an assumed effectiveness of 0.5%, would enable some 6 million smokers alive in 1995 to quit and would avert 1 million deaths. The cost-effectiveness of these interventions in low-income and middle-income countries has also been estimated. By weighing the public-sector costs of implementing and running tobacco-control programs against the years of healthy life saved, measured in disability-adjusted life years, or DALYs, we find that price increases on tobacco would be cost-effective in many circumstances. Depending on various assumptions, price increases could cost between US $4 and $34 per DALY in low-income and middle-income countries. Non-price measures are also cost-effective, ranging from $34 to $685 per DALY in low-income and middle-income countries. NRTs with public provision are also cost-effective in low-income and middle-income countries, ranging from $276 to $851 per DALY. Given that, in practice, there is substantial local variation in the likely effectiveness and costs of these interventions, local assessments are required to guide policy.