Evolving methodology of national tobacco control investment cases

Abstract

BackgroundThis article describes an investment case methodology for tobacco control that was applied in 36 countries between 2017 and 2022.MethodsThe WHO Framework Convention on Tobacco Control (FCTC) investment cases compared two scenarios: a base case that calculated the tobacco-attributable mortality, morbidity and economic costs with status quo tobacco control, and an intervention scenario that described changes in those same outcomes from fully implementing and enforcing a variety of proven, evidence-based tobacco control policies and interventions. Health consequences included the tobacco-attributable share of mortality and morbidity from 38 diseases. The healthcare expenditures and the socioeconomic costs from the prevalence of those conditions were combined to calculate the total losses due to tobacco. The monetised benefits of improvements in health resulting from tobacco control implementation were compared with costs of expanding tobacco control to assess returns on investment in each country. An institutional and context analysis assessed the political and economic dimensions of tobacco control in each context.ResultsWe applied a rigorous yet flexible methodology in 36 countries over 5 years. The replicable model and framework may be used to inform development of tobacco control cases in countries worldwide.ConclusionInvestment cases constitute a tool that development partners and advocates have demanded in even greater numbers. The economic argument for tobacco control provided by this set of country-contextualised analyses can be a strong tool for policy change.

Interpreting results, impacts and implications from WHO FCTC tobacco control investment cases in 21 low-income and middle-income countries

“…To place a value on deaths caused by tobacco use, years of life lost due to tobacco-attributable mortality were monetised using established economic valuation methods. 25 The economic value associated with workplace productivity losses due to smoking was estimated based on published estimates of lost work time due to absenteeism (additional days of work missed per year due to smoking-related illnesses), presenteeism (reduction in productivity due to smoking-related causes) and unsanctioned smoking breaks (additional time in breaks from work beyond what is allowed by law or employer). Parameter estimates for the amount of lost work time per person who smokes due to absenteeism, presenteeism and excess smoking breaks per employed worker who smokes came from previously published literature.…”

“… 5–7 Lost productivity was calculated by multiplying the average lost work time per person who smokes by the estimated number of employed adults who smoke by average wage rates in countries. 25 Adult smoking rates for these calculations were obtained from national data sources provided by country partners. In cases when country partners were unable to provide those data, country-specific adult smoking prevalence was obtained from the country profile from the most recent version of the WHO report on the global tobacco epidemic available at the time when the tobacco control investment case was conducted.…”

“…30 WHO FCTC tobacco demand-reduction measures analysed for country investment cases include the following: tax increases; smoke-free indoor air laws; regulations requiring graphical health warnings to be placed on tobacco packaging; regulations regarding plain packaging for tobacco products; bans on tobacco advertising, promotion and sponsorship; and mass media campaigns. For more information about specific measures included in tobacco control investment cases, evolutions in the methodology of policies modelled over time, and the inclusion of custom analyses for certain countries, please refer to the previous paper detailing the methodology for the investment cases 25 or the investment case reports prepared for each country that are available online. 27…”

“…The estimates of workplace productivity losses were also calculated for each year of the intervention scenario based on the estimated smoking prevalence forecasted for each year of the intervention scenario. 25 …”

“…Other papers in the supplement that this paper is included in provide additional information about the WHO FCTC and the FCTC 2030 project, 24 as well as the data and methods used to conduct WHO FCTC tobacco control investment cases from 2017 to 2022. 25 Information regarding the WHO FCTC tobacco control investment case methodology has previously been summarised in a published article synthesising results from four countries in the Americas. 26 Additional details regarding the data sources and methods for WHO FCTC tobacco control investment cases can also be found as part of country-specific investment case reports available online.…”