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Potential health benefits and cost effectiveness of tobacco tax increases and school intervention programs targeted at adolescents in the Netherlands
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Series / Report no.
RIVM rapport 260601002
Open Access
Type
Report
Language
en
Date
2006-05-09
Research Projects
Organizational Units
Journal Issue
Title
Potential health benefits and cost effectiveness of tobacco tax increases and school intervention programs targeted at adolescents in the Netherlands
Translated Title
Potentiele gezondheidswinst en kosten effectiviteit van accijnsverhogingen op tabaksproducten en interventieprogramma's op scholen gericht op jongeren in Nederland
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Abstract
Bij jongeren kan veel gezondheidswinst behaald worden door te voorkomen dat ze beginnen met roken. Een prijsverhoging van 20% op tabaksproducten verlaagt het aantal jeugdige rokers met bijna 20.000 op de korte termijn. De kosten effectiviteit van accijnsverhogingen wordt geschat op ongeveer 4.500 per gewonnen QALY. Dit is inclusief medische kosten in gewonnen levensjaren en exclusief een eventuele toename in accijnsopbrengsten. De gezondheidseffecten en kosten effectiviteit van diverse schoolprogramma's zijn nog onzeker. Bijna 90% van de volwassen (ex-)rokers is gestart met roken voor hun 18e. Vanuit het oogpunt van volksgezondheid is het daarom belangrijk om roken bij jongeren te ontmoedigen. Het doel van dit onderzoek was om de gezondheidswinst en kosteneffectiviteit te bepalen van twee maatregelen om tabaksgebruik onder jongeren te ontmoedigen, namelijk een accijnsverhoging en interventieprogramma's op scholen. De effecten na 1 jaar op het aantal rokers zijn vastgesteld op basis van literatuuronderzoek. Het RIVM Chronische Ziekten Model (CZM) is gebruikt om de lange termijn effecten op de volksgezondheid te schatten. Voor de schoolprogramma's zijn drie voorbeeldinterventies onderzocht, waarvan de kosten werden bepaald op 20 tot 75 per leerling. De schattingen van de gezondheidswinst en kosten effectiviteit als gevolg van de drie school interventies dienen voorzichtig te worden geinterpreteerd, vanwege grote onzekerheid over de precieze effecten van deze programma's op het rookgedrag van de jeugd. De conclusie van scenario analyses met het CZM is dat bij jongeren veel gezondheidswinst behaald kan worden door te voorkomen dat ze starten met roken. Een accijnsverhoging draagt hieraan bij en is een zeer doelmatige vorm van preventie.
Increasing tobacco taxes is a cost effective measure to reduce smoking among youth. A price increase on tobacco products reduces the number of young smokers by almost 20,000 in the short run. Although, in the end, effects of current price increases on smoking behaviour will fade away, tobacco taxes still are a good strategy to gain health effects since no intervention costs are involved. Cost effectiveness ratios for tobacco tax increases amount to 4,500 per QALY gained including medical costs in life years gained, but excluding tobacco tax revenues. This report presents estimates of health gains and cost effectiveness of two types of interventions targeted at smoking reduction among adolescents in the Netherlands: school interventions and tobacco tax increases. Effects in terms of smokers averted were determined from the literature. To translate these effects into health gains and cost effectiveness the RIVM Chronic Disease Model (CDM) is used. This dynamic population model allows estimating effects on smoking related diseases, gains in (quality adjusted) life years and differences in health care costs. For the school interventions, three different programs were investigated. The intervention costs per participant ranged from 20 to 75. Since there is much uncertainty about the effectiveness of the school interventions with regard to daily smoking among adolescents, results of the scenario analyses should be interpreted with caution. The conclusion that can be drawn from the scenario analyses with the CDM is that much health gains can be attained by preventing adolescents from smoking initiation and that tobacco tax increase may contribute to this in a cost effective way.
Increasing tobacco taxes is a cost effective measure to reduce smoking among youth. A price increase on tobacco products reduces the number of young smokers by almost 20,000 in the short run. Although, in the end, effects of current price increases on smoking behaviour will fade away, tobacco taxes still are a good strategy to gain health effects since no intervention costs are involved. Cost effectiveness ratios for tobacco tax increases amount to 4,500 per QALY gained including medical costs in life years gained, but excluding tobacco tax revenues. This report presents estimates of health gains and cost effectiveness of two types of interventions targeted at smoking reduction among adolescents in the Netherlands: school interventions and tobacco tax increases. Effects in terms of smokers averted were determined from the literature. To translate these effects into health gains and cost effectiveness the RIVM Chronic Disease Model (CDM) is used. This dynamic population model allows estimating effects on smoking related diseases, gains in (quality adjusted) life years and differences in health care costs. For the school interventions, three different programs were investigated. The intervention costs per participant ranged from 20 to 75. Since there is much uncertainty about the effectiveness of the school interventions with regard to daily smoking among adolescents, results of the scenario analyses should be interpreted with caution. The conclusion that can be drawn from the scenario analyses with the CDM is that much health gains can be attained by preventing adolescents from smoking initiation and that tobacco tax increase may contribute to this in a cost effective way.
Description
Publisher
Rijksinstituut voor Volksgezondheid en Milieu RIVM
Sponsors
VWS