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

• Published in: Addiction (Abingdon, England) Vol. 117; no. 9; pp. 2374 - 2392
• Main Authors: Jiang, Xiaobin, Jackson, Louise J., Syed, Muslim Abbas, Avşar, Tuba Saygın, Abdali, Zainab
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.09.2022
• Subjects: Abstracts; Affordability; Clinical outcomes; Consumption; Cost analysis; Cost-Benefit Analysis; Costs; Cost‐effectiveness; Data; Developing Countries; economic evaluation; Financial incentives; Generalizability; Health status; Humans; Intervention; LDCs; low‐ and middle‐income countries; Nicotine; Nicotine replacement therapy; Public health; Quality; Quality assessment; Quality control; Sensitivity analysis; Smoking; smoking cessation; Smoking Cessation - methods; Systematic review; Tax increases; Taxation; Tobacco; tobacco control; tobacco economics; Tobacco Products; Tobacco Use - prevention & control; Tobacco Use Cessation Devices; Transferability; tobacco economics; economic evaluation; low- and middle-income countries; smoking cessation; Cost-effectiveness; tobacco control
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.15821

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 s were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. Results This review identified 20 studies for inclusion. The studies evaluated a 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) and the model structure; sensitivity analyses were inadequately described in many studies; and there were 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 generalizability of the findings.