Heterogeneity in preferences for smoking cessation.

Promoting cessation is a cornerstone of tobacco control efforts by public-health agencies. Economic information to support cessation programs has generally emphasized cost-effectiveness or the impact of cigarette pricing and smoking restrictions on quit rates. In contrast, this study provides empirical estimates of smoker preferences for increased efficacy and other attributes of smoking cessation therapies (SCTs). Choice data were collected through a national survey of Canadian smokers. We find systematic preference heterogeneity for therapy types and SCT attributes between light and heavy smokers, as well as random heterogeneity using random parameters logit models. Preference heterogeneity is greatest between length of use and types of SCTs. We estimate that light smokers would be willing to pay nearly $500 ($CAN) to increase success rates to 40% with the comparable figure for heavy smokers being near $300 ($CAN). Results from this study can be used to inform research and development for smoking cessation products and programs and suggest important areas of future inquiry regarding heterogeneity of smoker preferences and preferences for other health programs.

Economic evaluation of the benefits of reducing acute cardiorespiratory morbidity associated with air pollution.

BACKGROUND: Few assessments of the costs and benefits of reducing acute cardiorespiratory morbidity related to air pollution have employed a comprehensive, explicit approach to capturing the full societal value of reduced morbidity. METHODS: We used empirical data on the duration and severity of episodes of cardiorespiratory disease as inputs to complementary models of cost of treatment, lost productivity, and willingness to pay to avoid acute cardiorespiratory morbidity outcomes linked to air pollution in epidemiological studies. A Monte Carlo estimation procedure was utilized to propagate uncertainty in key inputs and model parameters. RESULTS: Valuation estimates ranged from 13 dollars (1997, Canadian) (95% confidence interval, 0-28 dollars) for avoidance of an acute respiratory symptom day to 5,200 dollars (4,000 dollars-6,400 dollars) for avoidance of a cardiac hospital admission. Cost of treatment accounted for the majority of the overall value of cardiac and respiratory hospital admissions as well as cardiac emergency department visits, while lost productivity generally represented a small proportion of overall value. Valuation estimates for days of restricted activity, asthma symptoms and acute respiratory symptoms were sensitive to alternative assumptions about level of activity restriction. As an example of the application of these values, we estimated that the observed decrease in particulate sulfate concentrations in Toronto between 1984 and 1999 resulted in annual benefits of 1.4 million dollars (95% confidence interval 0.91-1.8 million dollars) in relation to reduced emergency department visits and hospital admissions for cardiorespiratory disease. CONCLUSION: Our approach to estimating the value of avoiding a range of acute morbidity effects of air pollution addresses a number of limitations of the current literature, and is applicable to future assessments of the benefits of improving air quality.