Cost-Effectiveness of Four Tobacco Control Interventions in Mongolia.

INTRODUCTION: The aim of this study is to quantify the cost-effectiveness of four tobacco control interventions: Tobacco taxation, mass media campaigns, school programs, and cessation support, and to illustrate how available evaluation tools can be adapted to the local setting. AIMS AND METHODS: We used the dynamic population health modeling-health impact assessment tool to project the future smoking prevalence associated with the interventions and to simulate the resulting smoking-related disease burden over time. Applying the most recent available national Mongolian data as input, the costs and effects of four interventions were compared to a business-as-usual scenario, resulting in costs per life year gained and per disability-adjusted life years (DALYs) averted. RESULTS: Three years after implementation, all interventions reduce the prevalence of current smoking, with the strongest reduction observed with the increase in tobacco tax (5.1% points), followed by mass media campaigns (1.6% points), school programs (1.3% points), and cessation support interventions (0.6% points). School programs were a cost-saving tobacco control intervention compared to current practice in Mongolia, while the other programs resulted in additional costs compared to business as usual. Compared to the World Health Organization (WHO) thresholds, all interventions would be considered "very cost-effective" in terms of cost per DALY averted (below US$ 4295 per DALY averted) in Mongolia. CONCLUSIONS: Large-scale interventions such as taxation and mass media campaigns result in both cost-effectiveness and important health benefits in relation to intervention costs. Reducing the prevalence of smoking among the male population would be particularly worthwhile in Mongolia. IMPLICATIONS: This study shows that in Mongolia school programs were a cost-saving intervention, while the cost-effectiveness ratios were US$ 25 per disability-adjusted life year (DALY) averted for mass media campaigns, US$ 74 for taxation, and US$ 1961 for cessation support interventions. Compared to the WHO thresholds, all interventions would be considered "very cost-effective" in terms of expenses per DALY averted (

Reducing the Burden of Disease Through Tobacco Taxes in Mongolia: A Health Impact Analysis Using a Dynamic Public Health Model.

BACKGROUND/OBJECTIVES: Smoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia's health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia. METHODS: The dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia's National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors. RESULTS: Over a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period. DISCUSSION: Prevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health. IMPLICATIONS: Tobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.

The costs of inappropriate referral pathways in inpatient care for three major noncommunicable diseases in Mongolia: a national registry-based analysis.

BACKGROUND: Non-communicable diseases (NCDs) consistently pose a huge economic burden to health systems and countries in general. The aim of this study was to quantify inpatient costs associated with chronic obstructive pulmonary disease, stroke and ischemic heart disease stratified by type of referral pathway, and to investigate key factors that drive these costs. METHODS: A registry-based data analysis was performed using national public hospital inpatient records from 2016 to 2018 for 117,600 unique patients and linking patient-level inpatient health care use with hospital-specific unit cost per bed-day. These were combined to calculate the annual inpatient costs for each of the three disorders per person and per year. Generalized linear modeling was used to assess the association of inpatient costs with age, gender, location, comorbidity, treatment referral pathways and years. RESULTS: Across three diagnoses, the majority of patients were female. Most were over 50-60 years old, with more than half being a pensioner, typically with at least one comorbidity. About 25% of patients followed what might be considered inappropriate (unofficial) inpatient referral pathways. Mean annual inpatient costs were int$ 721. These costs rose to int$ 849 for unofficial pathways and dropped to int$677 for official pathways. Further covariates significantly associated with high inpatient costs were location, age, gender, and comorbidity. CONCLUSION: Our findings provide background information essential to develop evidence-based and cost-effective interventions aimed at health promotion, prevention and service delivery. Reducing the unofficial use of inpatient care can improve efficient resource allocation in health care and prevent further escalation of inpatient costs in the future.

Smoking-attributable burden of lung cancer in Mongolia a data synthesis study on differences between men and women.

BACKGROUND: Smoking is widely recognized as one of the most prevalent and preventable causes of many cancer types. This study aimed to quantify the population attributable fraction (PAF) of the lung cancer burden for smoking in Mongolia. METHODS: Lung cancer incidence and lung cancer-related death data came from the population-based national registry covering the period 2007-2016. Smoking prevalence data came from the STEPwise approach (STEP) national survey. The lung cancer-related disease burden was calculated and expressed in Disability Adjusted Life Years (DALYs) lost by gender and by year. This was combined with current smoking and former smoking prevalence data, and relative risks (RR) of lung cancer-related deaths for current smokers and former smokers versus never smokers from region-specific cohort studies to estimate the PAF of lung cancer attributable to "ever-smoking" in Mongolia. RESULTS: Between 2007 and 2016, lung cancer accounted for the loss of over 63,000 DALYs in Mongolia. The PAF of lung cancer-related deaths attributable to current and former smoking combined was 58.1% (95% IR = 43.1%-72.2%) for men and 8.9% (95% IR = 4.1% -13.5%) for women. Smoking-attributable DALYs loss amounted to 2589 years (95% IR = 1907-3226) in 2016. CONCLUSIONS: A considerable health loss may be prevented with an effective anti-smoking policy. In Mongolia, more than one third of lung cancer-related DALY loss is attributable to active smoking, and thus is potentially preventable. Furthermore, a gender-specific tobacco control policy may be worthwhile because of the large gender difference in smoking exposure in Mongolia. Next to this, age specific policy, including a smoke-free generation policy for adolescents, with targeted education, and mass media campaigns is needed.

Informing policy makers on the efficiency of population level tobacco control interventions in Asia: A systematic review of model-based economic evaluations.

BACKGROUND: Economic evaluations of tobacco control interventions support decisions regarding resource allocation in public health policy. Our systematic review was aimed at identifying potential bias in decision models used to estimate the long-term costs and effects of population-based tobacco control interventions in Asia. METHODS: We included studies conducted in Asian countries and using a modelling technique to evaluate the economic impacts of one or more population-based tobacco interventions in line with the Framework Convention on Tobacco Control (FCTC). We assessed the structure, input parameters, and risk of bias for each model, and performed a narrative synthesis of the included studies. RESULTS: Nine model-based economic evaluation studies of population-based tobacco interventions were identified. About 60% of the criteria for reporting quality were met in all studies, indicating that reporting generally lacked transparency. The studies were highly heterogeneous in terms of the scope, types, and structures of their models and the quality of input parameters. One-third of the models applied in the studies scored a high risk of bias, with problems mostly falling into the following categories: model type, time horizons, and smoking transition probabilities. CONCLUSIONS: More data are needed to provide high-quality evidence regarding the cost-effectiveness of tobacco control policies in Asia. Strong evidence at the country level hinges on the availability of accurate estimates of the effects of the interventions, the relative risks of smoking, and the price elasticity of the demand for tobacco. Simple transfers of models built in Western populations do not suffice. PROTOCOL REGISTRATION: PROSPERO CRD 42019141679.