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A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat
Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 627 N. Washington Street, 2nd Floor, Baltimore, MD 21205, USA
Rand Corporation, 1776 Main Street, Room 4369, Santa Monica, CA 90401, USA
Public Health Foundation of India, Second Floor, 4/2, Sirifort Institutional Area, August Kranti Marg, New Delhi, 110016, India
State Tobacco Control Cell, Department of Health & Family Welfare, Government of Gujarat, 3rd Floor, Block No. 5/2, Dr. Jivraj Mehta Bhavan, Sector No. 10, Gandhinagar-Gujarat 382010, India
* Author to whom correspondence should be addressed.
Received: 25 March 2011; in revised form: 4 April 2011 / Accepted: 20 April 2011 / Published: 26 April 2011
Abstract: Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India’s Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.
Keywords: cost-effectiveness; public smoking bans; smoke free public places; secondhand smoke; tobacco smoking
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Donaldson, E.A.; Waters, H.R.; Arora, M.; Varghese, B.; Dave, P.; Modi, B. A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat. Int. J. Environ. Res. Public Health 2011, 8, 1271-1286.
Donaldson EA, Waters HR, Arora M, Varghese B, Dave P, Modi B. A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat. International Journal of Environmental Research and Public Health. 2011; 8(5):1271-1286.
Donaldson, Elisabeth A.; Waters, Hugh R.; Arora, Monika; Varghese, Beena; Dave, Paresh; Modi, Bhavesh. 2011. "A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat." Int. J. Environ. Res. Public Health 8, no. 5: 1271-1286.