Economic evaluation of tobacco control in Asia:Dynamic population health impact assessment in Mongolia

More than half of the world’s 1.3 billion smokers live in Asia and this continent is the largest tobacco consumer as well as producer. The tobacco smoking epidemic is still in its early stages and will remain a major public health threat in the coming decades. However, the use of evidence for prioritizing tobacco control interventions is limited, especially in low-middle-income countries. This is partly due to a lack of good quality evidence that is tailored to the local context. This thesis adds to tailored evidence to inform on the efficiency of tobacco control interventions in Asia. A literature review indicates that previous studies employed relatively little local data sources and suboptimal model structures when investigating the cost-effectiveness of population based tobacco control interventions. Then, for Mongolia, tailored evidence was gathered: the attributable fraction of lung cancer burden caused by tobacco smoking was 58% for men, while for women it was only 9%. The mean annual inpatient cost for patient with three major noncommunicable diseases were $721, or almost five times the per capita health expenditure ($149). Patients using self-referral had higher hospital costs.Combining all evidence, using taxes to increase cigarette prices by 75% (bringing the country up to the level suggested by the WHO) would reduce the prevalence of smoking by 1.2%points and gain more than 137 thousand quality-adjusted life years in the population of three million individuals. Mass media campaigns, tobacco taxation, school programs and cessation support were all very cost-effective, while the school program was cost-saving