Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania

BackgroundTobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost.AimsWe aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania.Materials and methodsA cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters.ResultsOur model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively.ConclusionsEven though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government’s ability to implement these interventions.背景：烟草消费是全球疾病负担的重要贡献来源。据估算，包括坦桑尼亚在内的众多低收入国家的吸烟率正持续攀升，尤其在女性与青年群体中更为显著。即便如此，该国烟草管控措施的推行效果却始终欠佳。由于缺乏关于何种措施有效、实施成本几何的相关证据，推动烟草管控领域投资的相关努力正遭遇瓶颈。 研究目的：本研究旨在评估坦桑尼亚基于人群的烟草管控策略在预防心血管疾病（CVD）方面的成本与成本效益。 材料与方法：本研究从政府方视角出发，采用基于Excel的马尔可夫（Markov）模型开展成本效益分析。在成本核算环节，我们遵循政府视角，运用分项投入法与分步核算方法完成相关测算。流行病学数据与效能参数均来源于已发表的学术文献。本研究以避免的残疾调整生命年（DALYs）作为核心结局衡量指标。为纳入模型参数的不确定性，我们借助Ersatz软件开展了概率敏感性分析。 结果：模型结果显示，五项烟草管控策略均具备极高的成本效益，其成本效益比均低于世界卫生组织（WHO）提出的人均国内生产总值（GDP）阈值。其中，提高烟草税的策略成本效益最优，而工作场所禁烟令的成本效益相对最弱，二者的成本效益比分别为5美元与267美元。 结论：尽管在坦桑尼亚，上述五项干预措施在心血管疾病预防方面均被证实具备极高的成本效益，但仍需开展更多关于预算影响分析的研究，以进一步评估政府推行这些干预措施的财政承载能力。