Handbook of Disease Burdens and Quality of Life Measures pp 1661-1679 | Cite as
The Health and Economic Consequences of Smoking and Smoking Cessation Interventions: The Dutch Perspective
Cigarette smoking causes a high health burden worldwide. This paper reviews trends in cigarette use, the health and economic consequences of smoking, and the cost-effectiveness of smoking cessation interventions ( cost-effectiveness analysis) from a Dutch perspective. The Netherlands are in the third phase of the smoking epidemic, but smoking prevalence is still around 28% in adults. The country ranks in the middle of European countries with respect to the implementation of tobacco control policies.
It has been estimated that about 20% of all life years lost, 7% of all disease-year equivalents, 13% of all Disability Adjusted Life Years (DALYs), and 4% of total health care costs in the Dutch population is attributable to smoking. This is far more than the burden attributable to other single risk factors. The overall life expectancy of a male smoker is 7.7 years less than the life expectancy of a male non-smoker. Hence, there is a lot to be gained from the prevention of smoking. Due to the severely reduced life expectancy, lifetime health care costs are lower in smokers than in never smokers.
Nevertheless, strong evidence exists that individual smoking cessation interventions consisting of counseling with or without pharmacotherapy are cost-effective. Collective policy measures like tobacco tax increases and mass media campaigns are probably even more efficient. In The Netherlands, structured stop advice by the general practitioner was found to be cost saving, looking at intervention costs net of savings from a reduced incidence of smoking related diseases. When health care costs for diseases not related to smoking that occur during the life years gained by smoking cessation are included, the cost-effectiveness worsens, but the ratios remain below €20,000 per Quality Adjusted Life Year (QALY). Despite this evidence, few smokers receive cessation aid and most try to stop without any professional support. Reimbursement of smoking cessation interventions might stimulate their use and indications were found that reimbursement might be cost-effective.
To conclude, smoking prevention will result in large health gains, but not in cost savings. Smoking cessation can realize a substantial health gain, even if quit rates are at most 20% and 75% of quitters relapses. Even when accounting for additional costs in life years gained, many smoking prevention and smoking cessation policy interventions are cost-effective with ratios ranging from a few thousand up to €20,000 per QALY.
KeywordsChronic Obstructive Pulmonary Disease Smoking Cessation Nicotine Replacement Therapy Smoking Prevalence Quality Adjust Life Year
List of Abbreviations:
chronic obstructive pulmonary disease
disability adjusted life years
framework convention on tobacco control
minimal intervention strategy by the general practitioner or his assistant (Huisartsen-Minimale Interventie Strategy)
mass media campaign
nicotine replacement therapy
quality adjusted life years
National Institute for Public Health and the Environment (RijksInstituut voor Volksgezondheid en Milieuhygiene)
Dutch Foundation for a Smokeless Future
World Health Organization
- De Hollander AEM, Hoeymans N, Melse J, van Oers JAM, Polder JJ. (2007). Care for Health. The 2006 Dutch Public Health Status and Forecasts Report. National Institute for Public Health and the Environment. Bohn Stafleu Van Loghum, Houten.Google Scholar
- Feenstra T, Van Baal P, Hoogenveen R, Vijgen S, Stolk E, Bemelmans W. (2005a). Cost-Effectiveness of Interventions to Reduce Tobacco Smoking in The Netherlands. An Application of the RIVM Chronic Disease Model. Report 260601003. National Institute for Public Health and the Environment (RIVM), Bilthoven.Google Scholar
- Joossens L, Raw M. (2007). Progress in Tobacco Control in 30 European Countries 2005 to 2007. Swiss Cancer League, Berne.Google Scholar
- Partnership Stop Smoking. (2004). Guideline for the Treatment of Tobacco Addicts. CBO, Institute for Quality Assurance in Health Care, Alphen aan de Rijn.Google Scholar
- RIVM. (2007). Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid (National Public Health Compass) version 3.12. National Institute for Public Health and the Environment, Bilthoven.Google Scholar
- Sloan FA, Ostermann J, Picone G, Conover C, Taylor DH. (2004). The Price of Smoking. The MIT press, Cambridge, MA.Google Scholar
- Smoke-Free-Partnership. (2006). Lifting the Smokescreen. ERSJ Ltd. Reproduction, Brussels.Google Scholar
- STIVORO. (2008). Website of STIVORO for a Smoke Free Future. Available at: www.stivoro.nl.
- Surgeon General. (2004). The Health Consequences of Smoking: A Report of the Surgeon General, 2004.Google Scholar
- Van Baal P, Vijgen S, Bemelmans W, Hoogenveen R, Feenstra T. (2005). Potential Health Benefits and Cost Effectiveness of Tobacco Tax Increases and School Intervention Programs Targeted at Adolescents in the Netherlands. National Institute for Public Health and the Environment (RIVM), Bilthoven.Google Scholar
- Van der Wilk E, Melse J, Den Broeder J, Achterberg P. (2007). Leren van de buren. Beleid publieke gezondheid internationaal bezien: roken, alcohol, overgewicht, depressie, gezondheidsachterstanden, jeugd, screening. Report 70051010. National Institute for Public Health and the Environment (RIVM), Bilthoven.Google Scholar
- Vijgen S, Van Gelder BM, Van Baal PHM, Zutphen M, Hoogenveen RT, Feenstra TL. (2006). Kosten en effecten van een pakket maatregelen voor tabaksontmoediging. National Institute for Public Health and the Environment (RIVM), Bilthoven.Google Scholar
- Vijgen SMC, van Baal PHM, Hoogenveen RT, de Wit GA, Feenstra TL. (2008). Health Educ Res. 23(2): 310–318.Google Scholar
- WHO. (2005). The European Health Report 2005. Public Health Action for Healthier Children and Populations. World Health Organization, Regional Office for Europe, Copenhagen.Google Scholar
- WHO. (2007a). World Health Organization, Regional Office for Europe. The European Tobacco Control Report 2007. World Health Organization, Regional Office for Europe, Copenhagen.Google Scholar
- WHO. (2007b). World Health Organization. Health for All database (HFA-DB). World Health Organization, Regional Office for Europe, Copenhagen.Google Scholar
- WHO. (2008). WHO Report on the Global Tobacco Epidemic, 2008. World Health Organization, Geneva.Google Scholar
- Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, Raftery JP, Aveyard PN, Hyde CJ, Barton PM. (2002). Health Technol Assess. 6: 1–245.Google Scholar