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    Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application of the RIVM Chronic Disease Model

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    Authors
    Feenstra TL
    van Baal PHM
    Hoogenveen RT
    Vijgen SMC
    Stolk E
    Bemelmans WJE
    Series/Report no.
    RIVM rapport 260601003
    Type
    Report
    Language
    en
    
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    Title
    Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application of the RIVM Chronic Disease Model
    Translated Title
    Kosteneffectiviteit van tabaksontmoedigingsbeleid in Nederland. Een toepassing van het RIVM Chronische Ziekten Model
    Publiekssamenvatting
    Accijnsverhogingen, massamediale campagnes en individuele ondersteuning bij stoppen met roken zijn alle doelmatige vormen van preventie. Een accijnsverhoging is de meest doelmatige maatregel vanuit het gezondheidszorgperspectief. Deze maatregel levert veel gezondheidswinst op tegen relatief lage kosten.
    Roken is in Nederland de belangrijkste risicofactor voor voortijdige sterfte en leidt tot veel gezondheidsverlies. Het Ministerie van VWS streeft daarom naar minder rokers. Bij volwassenen richt het beleid zich vooral op de bevordering van het stoppen met roken. Bij jongeren is preventie belangrijk. Dit rapport biedt inzicht in de kosteneffectiviteit van diverse effectieve interventiemogelijkheden bij volwassenen.
    Iemand die stopt met roken loopt minder risico op een aan roken gerelateerde ziekte, en zal gemiddeld genomen langer leven. De gezondheidswinst van stoppen met roken is gemeten in zogeheten Quality Adjusted Life Years (QALYs), voor kwaliteit van leven gecorrigeerde levensjaren. Een winst van 1 QALY staat gelijk aan een extra jaar leven in goede gezondheid. In de extra levensjaren zullen ook zorgkosten optreden. Om de doelmatigheid van het tabaksontmoedigingsbeleid te beoordelen vanuit het gezondheidszorgperspectief zijn deze kosten en de kosten van verschillende beleidsmaatregelen afgezet tegen de besparingen bij rookgerelateerde ziektes en de gezondheidswinst.
    De kosteneffectiviteit van massamediale campagnes ligt dan beneden de 10.000 euro per QALY en voor een accijnsverhoging rond de 5000 euro per QALY. Een gestructureerd advies door de huisarts is de doelmatigste vorm van individuele hulp bij stoppen met roken en kost ongeveer 9000 euro per QALY. Zonder kosten in gewonnen levensjaren mee te rekenen zijn deze interventies kostenbesparend.
    De conclusie is dat maatregelen om het stoppen met roken te bevorderen bij volwassenen doelmatige vormen van preventie zijn, met een gunstige kosteneffectiviteit, zelfs als de kosten in gewonnen levensjaren zijn meegeteld.

    Introduction:Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults.
    Objective:To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion.
    Methods: Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates.
    Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3 euro) and costs per QALY were below 10.000 euro.The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400 euro. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 euro for structured GP stop-advice (H-MIS) to 21,500 euro for telephone counseling for implementation periods of 5 years.
    Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.
    Publisher
    Rijksinstituut voor Volksgezondheid en Milieu RIVM
    Sponsors
    VWS
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