Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review

Xiaobin Jiang, Louise Jackson, Muslim Syed, Tuba Saygin Avsar, Zainab Abdali

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: Tobacco consumption and its associated adverse outcomes remain major public health issues particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries.

Methods: Electronic databases including EMBASE, MEDLINE and PsycINFO, and the grey literature were searched using terms such as ‘tobacco’, ‘economic evaluation’ and ‘smoking’ from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesise the findings of the studies.

Results: This review identified 20 studies for inclusion. The studies evaluated wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data), the model structure and sensitivity analyses were inadequately described in many studies, and issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies.

Conclusions: There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalisability of the findings.
Original languageEnglish
JournalAddiction
Early online date8 Mar 2022
DOIs
Publication statusE-pub ahead of print - 8 Mar 2022

Keywords

  • Tobacco control
  • low- and middle-income countries
  • smoking cessation
  • cost-effectiveness
  • economic evaluation
  • tobacco economics

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