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Researches Health financing

I. Background

Tobacco smoking is the leading cause of mortality in the world and Vietnam. Tobacco smoking related morbidity and mortality cause severe losses to the health and economy to individuals and the whole society. The Government of Vietnam has issued the “National policy on tobacco control” in 2000-2010 period and drafted the Tobacco Control Law with the aim to reduce smoking rate and related losses to each individual, family and whole society. Which measure to select, which level of intervention and effectiveness are important questions that need highly reliable answers to help the Government develop effective tobacco control policies. 

II. Study objectives
To provide Vietnamese policy makers scientific evidence on costs and effectiveness of tobacco control intervention policies and make recommendations on policy options to reduce tobacco smoking related harms.
III. Study methods
The study employs the cost-effectiveness analysis (CEA) method and the multi-state life-table model to analyze the cost-effectiveness of 4 tobacco control intervention policies, including (1) increase luxury taxes imposed on tobacco commodity, (2) graphic health warning, (3) strong communication campaigns on tobacco harms, and (4) ban smoking in workplaces and indoor places.
IV. Study results
Graphic health warnings intervention is the least expensive (1,492 million VND), followed by increasing luxury taxes on tobacco products (11,827 million VND). Communication campaigns are very expensive (147,588 million VND). Banning smoking at workplaces, public and indoor places are most expensive (213,850 million VND).
The health effectiveness obtained by tax increase depends on the level of tax increase. When luxury tax increases from 55% to 65%, about 1,390 million DALYs would be preventable. When it raises to 75% and 85%, the figure would be 2,788 and 4,050, respectively. Tobacco smoke banning in indoor places will help prevent 3,099 million DALY. Smoking ban in workplaces will help to prevent 637 million DALYs, bringing about lest health benefits among reviewed interventions. Graphic health warning is a very effective intervention (preventing 2,996 million DALYs). Interventions by communication campaigns help to prevent 1,873 million DALYs. 
All the above interventions are very “effective” compared with WHO cost-effectiveness standards. Graphic health warning is the most cost-effective one (558 VND/prevented DALY). Tax increase ranks second and higher tax rates bring about more effectiveness: 8,600 VND, 4,215 VND  and 2,902 VND per DALY prevented for the tax rate increase of 55% to 65%, 55% to 75% and 55% to 85%, respectively. The ICER ratio of communication campaign is 67,900 VND/DALY prevented, smoking ban in indoor and public places 78,260 VND/DALY prevented, and smoking ban at workplaces 336,800 VND/DALY prevented. 
V. Conclusion 
All the 4 interventions are very “effective” compared with WHO cost-effectiveness standards in both cases: including and excluding cost compensation
Graphic health warning is the most cost-effective intervention, followed by luxury tax increase, communication campaign, smoking ban in public places and smoking ban at workplaces. 

VI. Recommendations
Increase luxury taxes imposed on tobacco commodity; apply graphic health warning; carry out strong communication campaigns on tobacco related harms; ban smoking at workplaces and indoor public places. All these can improve health for the population and save costs of treatment tobacco related diseases in the future
All interventions should be prioritized when proposing tobacco control policy 
In the context of resources prioritization and intervention selection by priority, graphic health warning is the most effective, followed by tax increase, communication campaign, smoking ban in public places and smoking ban at workplaces.



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