UAE Teen Smoking Initiative: Cost Effectiveness Analysis

Problem Statement

There is a need to reduce teenage smoking of all types of tobacco and tobacco products in the UAE to reduce the incidence of long-term health conditions such as heart disease, cancer, hypertension, and other problems. While the government has established strong regulations on controlling the sale of tobacco products to minors, the rules have proved less than effective at stemming the availability of tobacco to teens, as demonstrated by the sharp increase in teen smoking over the years from 2005 to 2010. Thus, this research study attempts to determine if interventions with the teenage population can reduce the amount of smoking by teenagers in the UAE.

Methods Used in Study

This pilot study involved 27 University of Sharjah students who smoke and who volunteered for a stop-smoking program; the university is located in Sharjah (near Dubai). The analytic horizon for this analysis is the patient’s perspective. The outcome measure used is the number of teenagers who quit.

Results and Cost Effectiveness Analysis

The results of the cost effectiveness analysis are shown in the figure on the next page. For this case, the goal was to reduce teen smoking in the UAE. Two alternatives were considered. First, the Internet-based intervention, and second no unusual intervention beyond normal health care. For each of those, there were two possibilities: that the teen would quit smoking, or that the teen would not quit working. Based on experience with this study, it is anticipated that about40% of the teens receiving the Internet-based intervention would quit smoking as a result of the intervention; the other 60% would not. For those receiving no intervention, the best estimate is that approximately 3% would quit spontaneously, but that 97% would not quit. While it is expected that those who do not quit may be subject to heart disease, COPD, lung cancer, stroke and other results of a history of smoking, there is no easy way to estimate those costs at this time. On the other hand, again based on these results it is expected that a teenager will spend approximately $1500/year on cigarettes or other paraphernalia associated with smoking (Consumer Goods and retail report, 2010).

Estimated costs for the Internet intervention for 50 participants are $6160, which includes domain hosting (development of website is done by a student as an Independent study for credit); cost of printed handouts; cost of travel from Health Care City to the university once a month; and total labor costs. For the non-intervention group, costs are estimated as $1310 for 50 participants (total of 100 participants). Thus the expected value for the intervention option is $600 per participant in the intervention, while the expected value of the non-intervention group is $45 per participant in the non-intervention group.

Interpretation

The effectiveness cost of the intervention (for 50 participants) is estimated to be:

Outcome savings – cost of intervention = $30,000 - $6100 = $23, 900

For the non-intervention group (for 50 participants):

Outcome savings – cost of intervention = $2250 - $1310 = $940

The intervention generates almost $24,000 of savings, compared to the $940 generated by the non-intervention group. Thus, it makes more sense to continue with the intervention. The proposed intervention is cost effective.

There are, of course, other impacts of the smoking issue. It is very difficult for a small sample to determine both the probability of developing a major disease as a result of smoking, or the cost of that disease; thus those factors are not feasible to use in this analysis. The most direct outcome measurement available is simply the number of teenagers who actually quit. It should be noted that some teens will quit spontaneously, thus there is a 3% (estimated) likelihood of that happening in the non-intervention group, i.e., 1or 2 of those students would quit during the study. Since the outcome is a measure of the money saved by the students (this being from the participant’s perspective), those savings for all 50 participants in the group, less the cost of the intervention, generates the ultimate results of the program. In this case, the savings are five times the cost of the intervention. In terms of overall policy impact, this analysis indicates that an Internet-based intervention to reduce teenage smoking in UAE adolescents is both cost-effective and significantly reduces long-term health costs for the healthcare system. While exact health costs cannot be easily gauged, it is known that smoking causes a variety of chronic diseases including cancer, heart disease, emphysema, chronic obstructive pulmonary diseases and others. Any significant reduction in the incidence of such diseases provides significant long-term savings to the healthcare system.

This proposed system also has the advantage of being fairly easy to scale upward. While this pilot study involved only 50 participants, because of the nature of Internet-based interventions, expanding that by a factor of 10 or even 100 presents few technological issues. The greatest problem in such scalability is that there is a requirement for an orientation meeting to get participants started on the program. With careful planning, this should not be a logistical problem for the Health Ministry to carry out.

It is thus recommended that the Health Ministry consider establishing a policy that encourages the implementation of a program such as this on a larger scale in order to help reduce the number of teenage smokers in the U.A.E. While not a complete solution to the problem—only 40% of the participants in the intervention group succeeded in quitting—it provides a cost-effective, easy to implement tool that can assist in reducing long-term healthcare costs to UAE teens and young adults.