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Nguyễn  Khánh Phương, Trần Văn Tiến, Hoàng Thị Phượng, Vương Lan Mai, Nguyễn Thị Thủy

Place of publication: Health Strategy and Policy Institute
Year of publication:  2010

Tobacco smoking is the leading cause of mortality in the world and Vietnam. 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. 

To provide Vietnamese policy makers scientific evidence on the costs-effectiveness of tobacco control intervention policies and make recommendations on policy options to reduce tobacco smoking related harms.
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) Excise taxes increase, (2) graphic warning label, (3) mass media campaigns on tobacco harms, and (4) smoking ban in workplaces and indoor places.
Graphic warnings label intervention is the least expensive (1,492 million VND), followed by increasing excise taxes on tobacco products (11,827 million VND). Mass media  campaigns are very expensive (147,559 million VND). Smoking ban 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 tax increases from 55% to 65%, about 1.390 million DALYs would be averted. When it raises to 75% and 85%, the figure would be 2.788 and 4.050 respectively. Tobacco smoking ban in indoor places will help avert 3.099 million DALYs. Smoking ban in workplaces will help to avert 637 thousands DALYs, bringing about lest health benefits among reviewed interventions. Graphic warning label is a very effective intervention (2.996 million DALYs averted). Mass media campaigns intervention help to avert 1.873 million DALYs. 
All the above interventions are “very cost effective” given WHO threshold definition of < GDP per capita. Graphic warning label is the most cost-effective one (500 VND/DALY averted). Tax increase ranks second and higher tax rates bring about more effectiveness: 8,600 VND, 4,200 VND and 2,900 VND per DALY averted for the tax rate increase of 55% to 65%, 55% to 75% and 55% to 85%, respectively. The ICER of mass media campaigns intervention is 78,300 VND/DALY averted, smoking ban in indoor and public places 67,900 VND/DALY averted, and smoking ban at workplaces 336,800 VND/DALY averted. 
All the 4 interventions are “very cost effective” given WHO threshold <GDP per capita in both cases: with or without cost-offsets .
Graphic warning label is the most cost-effective intervention, followed by excise tax increase, mass media campaigns, smoking ban in public places and smoking ban at workplaces. 
Carrying out interventions of increase of excise tax imposed on tobacco commodity, graphic health warning label, mass media campaigns on tobacco related harms, smoking ban at workplaces and indoor public places 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 label is the most effective, followed by tax increase, mass media campaigns, smoking ban in public places and smoking ban at workplaces.


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